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  1. Does Lower Limb Exercise Worsen Renal Artery Hemodynamics in Patients with Abdominal Aortic Aneurysm?

    OpenAIRE

    Sun, Anqiang; Tian, Xiaopeng; Zhang, Nan; Xu, Zaipin; Deng, Xiaoyan; Liu, Ming; Liu, Xiao

    2015-01-01

    Renal artery stenosis (RAS) and renal complications emerge in some patients after endovascular aneurysm repair (EVAR) to treat abdominal aorta aneurysm (AAA). The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and ...

  2. Does lower limb exercise worsen renal artery hemodynamics in patients with abdominal aortic aneurysm?

    Directory of Open Access Journals (Sweden)

    Anqiang Sun

    Full Text Available Renal artery stenosis (RAS and renal complications emerge in some patients after endovascular aneurysm repair (EVAR to treat abdominal aorta aneurysm (AAA. The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and post-operative models of the abdominal aorta were reconstructed based on CT images. The hemodynamic environment was numerically simulated under rest and lower limb exercise conditions. The results revealed that in the renal arteries, lower limb exercise decreased the wall shear stress (WSS, increased the oscillatory shear index (OSI and increased the relative residence time (RRT. EVAR further enhanced these effects. Because these parameters are related to artery stenosis and atherosclerosis, this preliminary study concluded that lower limb exercise may increase the potential risk of inducing renal artery stenosis and renal complications for AAA patients. This finding could help elucidate the mechanism of renal artery stenosis and renal complications after EVAR and warn us to reconsider the management and nursing care of AAA patients.

  3. Does lower limb exercise worsen renal artery hemodynamics in patients with abdominal aortic aneurysm?

    Science.gov (United States)

    Sun, Anqiang; Tian, Xiaopeng; Zhang, Nan; Xu, Zaipin; Deng, Xiaoyan; Liu, Ming; Liu, Xiao

    2015-01-01

    Renal artery stenosis (RAS) and renal complications emerge in some patients after endovascular aneurysm repair (EVAR) to treat abdominal aorta aneurysm (AAA). The mechanisms for the causes of these problems are not clear. We hypothesized that for EVAR patients, lower limb exercise could negatively influence the physiology of the renal artery and the renal function, by decreasing the blood flow velocity and changing the hemodynamics in the renal arteries. To evaluate this hypothesis, pre- and post-operative models of the abdominal aorta were reconstructed based on CT images. The hemodynamic environment was numerically simulated under rest and lower limb exercise conditions. The results revealed that in the renal arteries, lower limb exercise decreased the wall shear stress (WSS), increased the oscillatory shear index (OSI) and increased the relative residence time (RRT). EVAR further enhanced these effects. Because these parameters are related to artery stenosis and atherosclerosis, this preliminary study concluded that lower limb exercise may increase the potential risk of inducing renal artery stenosis and renal complications for AAA patients. This finding could help elucidate the mechanism of renal artery stenosis and renal complications after EVAR and warn us to reconsider the management and nursing care of AAA patients.

  4. [Renal hemodynamics and albuminuria in patients with arterial hypertension].

    Science.gov (United States)

    Stríbrná, J; Englis, M; Peregrin, J; Belán, A; Růzicka, M

    1995-12-06

    The cause of hyperalbuminuria in hypertonic patients can be functional or irreversible structural changes. The objective of the present investigation was an attempt to differentiate these two possibilities by comparing data of hypertonic patients with normal albuminuria (albumin excretion value for microalbuminuria. The results suggest that microalbuminuria in hypertensive patients is as a rule a manifestation of structural renal changes, while also functional and reversible changes participate. The asset of treatment of hypertension by angioplasty of the renal arteries was manifested not only in the renal haemodynamics but also by reduced albuminuria.

  5. Radioindication of hemodynamics and functional state of parenchyma of the kidneys in stenosis of renal arteries

    International Nuclear Information System (INIS)

    Efimov, O.N.; Gabuniya, R.I.; Kamynin, Yu.F.; Matveenko, E.G.; Buyuklyan, A.N.; Skoropad, L.S.; Syzgantseva, L.M.

    1978-01-01

    Hemodynamics and functional state of parenchyma of the kidney were studied in 39 patients with stenosis of the renal arteries by means of pertechnetate 99 Tc, hippuran 131 I and chlormerodrine 197 Hg. In patients with vasorenal hypertension the following changes in the stenosed kidney were revealed: a significant decrease in the renal blood flow, renal fraction, volume of maximal saturation, specific blood flow, systolic renal index; elevation of the intrarenal vascular resistance; and impairment of the functional state of the renal parenchyma. It was established that there was a direct dependence between the renal blood flow and the volume of maximal saturation and a reverse dependence between the renal blood flow and intrarenal vascular resistance. Hemodynamic changes in the stenosed kidney played an important role and led at first to a bias in renographic indices and then - to a decrease in accumulation of chlormerodrine 197 Hg in the kidneys. It was noted that changes in the functional state of the renal parenchyma tended to be dependent upon the level of the renal blood flow, and indices of the renal blood flow - upon the values of arterial pressure. From diagnostic point of view, methods of radioiangiography, as compared with renography and scintigraphy, were found to be the most informative

  6. Renal hemodynamics: the influence of the renal artery ostium flow diverter

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    Rossmann, Jenn Stroud; Albert, Scott; Balaban, Robert

    2013-11-01

    The recently identified renal artery ostium flow diverter may preferentially direct blood flow to the renal arteries, and may also influence flow patterns and recirculation known to be involved in atherogenesis. Three-dimensional computational fluid dynamics (CFD) simulations of steady and pulsatile blood flow are performed to investigate the influence of diverter size and position, and vascular geometry, on the flow patterns and fluid mechanical forces in the neighborhood of the diverter. CFD results show that the flow diverter does affect the blood distribution: depending on the diverter's position, the flow to the renal arteries may be increased or reduced. The results of simulations also show the diverter's effect on the Wall Shear Stress (WSS) distribution, and suggest that the diverter contributes to an atherogenic environment in the abdominal aorta, while being atheroprotective in the renal arteries themselves. These results support previous clinical findings, and suggest directions for further clinical study. The results of this work have direct implications in understanding the physiological significance of the diverter, and its potential role in the pathophysiological development of atherosclerosis.

  7. Renal hemodynamics and renin-angiotensin system activity in humans with multifocal renal artery fibromuscular dysplasia.

    Science.gov (United States)

    van Twist, Daan J L; Houben, Alphons J H M; de Haan, Michiel W; de Leeuw, Peter W; Kroon, Abraham A

    2016-06-01

    Fibromuscular dysplasia (FMD) is the second most common cause of renovascular hypertension. Nonetheless, knowledge on the renal microvasculature and renin-angiotensin system (RAS) activity in kidneys with FMD is scarce. Given the fairly good results of revascularization, we hypothesized that the renal microvasculature and RAS are relatively spared in kidneys with FMD. In 58 hypertensive patients with multifocal renal artery FMD (off medication) and 116 matched controls with essential hypertension, we measured renal blood flow (Xenon washout method) per kidney and drew blood samples from the aorta and both renal veins to determine renin secretion and glomerular filtration rate per kidney. We found that renal blood flow and glomerular filtration rate in FMD were comparable to those in controls. Although systemic renin levels were somewhat higher in FMD, renal renin secretion was not elevated. Moreover, in patients with unilateral FMD, no differences between the affected and unaffected kidney were observed with regard to renal blood flow, glomerular filtration rate, or renin secretion. In men, renin levels and renin secretion were higher as compared with women. The renal blood flow response to RAS modulation (by intrarenal infusion of angiotensin II, angiotensin-(1-7), an angiotensin II type 1 receptor blocker, or a nitric oxide synthase blocker) was also comparable between FMD and controls. Renal blood flow, glomerular filtration, and the response to vasoactive substances in kidneys with multifocal FMD are comparable to patients with essential hypertension, suggesting that microvascular function is relatively spared. Renin secretion was not increased and the response to RAS modulation was not affected in kidneys with FMD.

  8. Obesity and renal hemodynamics

    NARCIS (Netherlands)

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.

    2006-01-01

    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  9. Renal dysfunction and state of metabolic and hemodynamic factors in patients with arterial hypertension

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    Klochkov V.A.

    2011-12-01

    Full Text Available The aim of the investigation is to carry out comparative evaluation of metabolic and hemodynamic indices in patients with arterial hypertension (AH and renal dysfunction; to study the interrelation between arterial blood pressure level normalization and the presence or lack of microalbuminuria (MAU in the morning urine portion of patients with AH after therapy with antihypertensive preparations (APs of various groups. Methods. 121 persons have been investigated, 91 out — patients of both sexes, aged 33-55, with the diagnosis of arterial hypertension of stage II risk III, who have been taking Perindopril, Telmisartan and Bisoprolol for3 months. The control of arterial pressure level, biochemical analysis of metabolic indices and morning urine portion test for microalbuminuria has been carried out. Results. MAU has been revealed in 17,6% patients, occurring more frequently in men than in women. Microalbuminuria is accompanied by reliable decrease of total and ionized calcium and magnesium concentrations, an increase of potassium level in blood plasma, increase of cholesterol, triglycerides, glucose and levels. Patients with AH and renal dysfunction reliably demonstrate higher levels of systolic and diastolic arterial pressure in the morning and evening hours, their normalization effect after APs intake is significantly interconnected with MAU presence. Conclusion. In patients with AH and MAU the main risk factors of cardio-vascular diseases development are more expressed. Microalbuminuria is a risk factor in patients with arterial hypertension and may influence on the basic blood electrolyte balance. While carrying out antihypertensive therapy the presence of MAU should be taken into consideration

  10. Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

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    Sun, Zhonghua; Chaichana, Thanapong [Curtin University of Technology, Perth (Australia)

    2010-02-15

    We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair.

  11. Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

    International Nuclear Information System (INIS)

    Sun, Zhonghua; Chaichana, Thanapong

    2010-01-01

    We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair

  12. Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review

    NARCIS (Netherlands)

    van Brussel, Peter M.; van de Hoef, Tim P.; de Winter, Robbert J.; Vogt, Liffert; van den Born, Bert-Jan

    2017-01-01

    Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional

  13. How to measure renal artery stenosis - a retrospective comparison of morphological measurement approaches in relation to hemodynamic significance

    International Nuclear Information System (INIS)

    Andersson, Malin; Jägervall, Karl; Eriksson, Per; Persson, Anders; Granerus, Göran; Wang, Chunliang; Smedby, Örjan

    2015-01-01

    Although it is well known that renal artery stenosis may cause renovascular hypertension, it is unclear how the degree of stenosis should best be measured in morphological images. The aim of this study was to determine which morphological measures from Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) are best in predicting whether a renal artery stenosis is hemodynamically significant or not. Forty-seven patients with hypertension and a clinical suspicion of renovascular hypertension were examined with CTA, MRA, captopril-enhanced renography (CER) and captopril test (Ctest). CTA and MRA images of the renal arteries were analyzed by two readers using interactive vessel segmentation software. The measures included minimum diameter, minimum area, diameter reduction and area reduction. In addition, two radiologists visually judged the diameter reduction without automated segmentation. The results were then compared using limits of agreement and intra-class correlation, and correlated with the results from CER combined with Ctest (which were used as standard of reference) using receiver operating characteristics (ROC) analysis. A total of 68 kidneys had all three investigations (CTA, MRA and CER + Ctest), where 11 kidneys (16.2 %) got a positive result on the CER + Ctest. The greatest area under ROC curve (AUROC) was found for the area reduction on MRA, with a value of 0.91 (95 % confidence interval 0.82–0.99), excluding accessory renal arteries. As comparison, the AUROC for the radiologists’ visual assessments on CTA and MRA were 0.90 (0.82–0.98) and 0.91 (0.83–0.99) respectively. None of the differences were statistically significant. No significant differences were found between the morphological measures in their ability to predict hemodynamically significant stenosis, but a tendency of MRA having higher AUROC than CTA. There was no significant difference between measurements made by the radiologists and measurements made with

  14. RENAL HEMODYNAMICS AND GLOMERULAR FILTRATION RATE IN MEN AND WOMEN WITH ARTERIAL HYPERTENSION AT THE AGE OF 40-60 YEARS

    OpenAIRE

    I. G. Fomina; A. E. Bragina; N. E. Gaydamakina; J. N. Salimzhanova

    2015-01-01

    Aim. To study parameters of a renal hemodynamic and the general glomerular filtration rate (GGFR) and their correlations with cardiovascular risk factors (RF) in patient with arterial hypertension (AH).Material and methods. 102 patients with AH (35 men and 67 women of 40-60 y.o.) were involved in the study. 20 persons (10 men and 10 women) with normal blood pressure (BP) were included in control group. Dynamic renal angioscintigraphy was used for an estimation of a renal hemodynamic and GGFR....

  15. Assessment of hemodynamic changes in patients with renal artery stenosis by means of the cine MR phase-contrast technique

    International Nuclear Information System (INIS)

    Schoenberg, S.O.; Knopp, M.V.; Bock, M.; Essig, M.; Hawighorst, H.; Zuna, I.; Schad, L.; Kaick, G. van; Kallinowski, F.; Allenberg, J.R.; Just, A.

    1997-01-01

    Purpose: To evaluate the use of high-temporal resolution cine MR phase-contrast flow measurements for assessment of flow dynamics in renal artery stenosis (RAS). Material and methods: In a dog model, cine MR flow measurements were validated by comparing the MR flow data to an invasive transit-time ultrasound reference technique for different degrees of RAS. Cardiac-gated MR flow curves were recorded in 56 renal arteries of 28 patients with a temporal resolution of at least 32 ms. In all cases RAS was confirmed by digital subtraction angiography (DSA). Abnormalities of flow dynamics were assessed in the calculated flow curves using the MR parameters mean flow, maximum velocity, and time to systolic maximum. Results: By means of the MR blood flow paremeters high-grade stenoses (>50%, n=23) were detected with sensitivity of 100% and specificity of 94% with reference to DSA. The overall differentiation between stenoses (n=37) and non-stenosed vessels (n=19) revealed a sensitivity of 87% and a specificity of 100%. Conclusion: Analysis of cardiac-gated MR flow curves provides a non-invasive method to assess the hemodynamic significance of RAS and thus allows a functional evaluation in relation to the morphologic characteristics of the stenosis. (orig.) [de

  16. RENAL HEMODYNAMICS AND GLOMERULAR FILTRATION RATE IN MEN AND WOMEN WITH ARTERIAL HYPERTENSION AT THE AGE OF 40-60 YEARS

    Directory of Open Access Journals (Sweden)

    I. G. Fomina

    2015-12-01

    Full Text Available Aim. To study parameters of a renal hemodynamic and the general glomerular filtration rate (GGFR and their correlations with cardiovascular risk factors (RF in patient with arterial hypertension (AH.Material and methods. 102 patients with AH (35 men and 67 women of 40-60 y.o. were involved in the study. 20 persons (10 men and 10 women with normal blood pressure (BP were included in control group. Dynamic renal angioscintigraphy was used for an estimation of a renal hemodynamic and GGFR.Results. Hypertensive women had lower renal blood flow and GGFR than these in men (p<0,000. Renal hemodynamics and GGFR in men and women did not differ in control group. Positive correlation  r=0,61; p<0,05 between GGFR and a tobacco smoking was found in hypertensive men as well as negative correlation (r=-0,41; p<0,005 between GGFR and body mass index (BMI in women.Conclusion. Renal blood flow and GGFR are lower in hypertensive women than these in men. Positive correlation between GGFR and tobacco smoking and negative correlation between GGFR and BMI were found in men and women respectively.

  17. Hemodynamics in Transplant Renal Artery Stenosis and its Alteration after Stent Implantation Based on a Patient-specific Computational Fluid Dynamics Model

    Science.gov (United States)

    Wang, Hong-Yang; Liu, Long-Shan; Cao, Hai-Ming; Li, Jun; Deng, Rong-Hai; Fu, Qian; Zhang, Huan-Xi; Fei, Ji-Guang; Wang, Chang-Xi

    2017-01-01

    Background: Accumulating studies on computational fluid dynamics (CFD) support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis (TRAS) and its alteration after stent treatment. Methods: Computed tomography angiography (CTA) data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery (TRA) was reconstructed from the qualified CTA images and categorized into three groups: the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress (WSS), and mass flow rate (MFR) were extracted. The data of hemodynamic parameters were expressed as median (interquartile range), and Mann–Whitney U-test was used for analysis. Results: Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS (2.94 [2.14, 3.30] vs. 1.06 [0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P = 0.001; 3.25 [2.67, 3.56] vs. 1.65 [1.18, 1.72] m/s, 281.3 [184.3, 364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P = 0.001) and lower minimal WSS and MFRs (0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P = 0.001; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P = 0.001) as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS. Conclusions: Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or

  18. Hemodynamics in Transplant Renal Artery Stenosis and its Alteration after Stent Implantation Based on a Patient-specific Computational Fluid Dynamics Model.

    Science.gov (United States)

    Wang, Hong-Yang; Liu, Long-Shan; Cao, Hai-Ming; Li, Jun; Deng, Rong-Hai; Fu, Qian; Zhang, Huan-Xi; Fei, Ji-Guang; Wang, Chang-Xi

    Accumulating studies on computational fluid dynamics (CFD) support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis (TRAS) and its alteration after stent treatment. Computed tomography angiography (CTA) data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery (TRA) was reconstructed from the qualified CTA images and categorized into three groups: the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress (WSS), and mass flow rate (MFR) were extracted. The data of hemodynamic parameters were expressed as median (interquartile range), and Mann-Whitney U-test was used for analysis. Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS (2.94 [2.14, 3.30] vs. 1.06 [0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P= 0.001; 3.25 [2.67, 3.56] vs. 1.65 [1.18, 1.72] m/s, 281.3 [184.3, 364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P= 0.001) and lower minimal WSS and MFRs (0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P= 0.001; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P= 0.001) as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS. Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or ameliorate deleterious change of hemodynamic

  19. Renal artery pseudoaneurysm

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    Luiz Inácio Roman

    Full Text Available Abstract The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT. This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

  20. Renal hemodynamics and oxygenation in transient renal artery occluded rats evaluated with iron-oxide particles and oxygenation-sensitive imaging

    International Nuclear Information System (INIS)

    Pedersen, Michael; Aarhus Univ.; Univ. Victor Segalen Bordeaux 2; Laustsen, Christoffer; Perot, Vincent; Grenier, Nicolas; Basseau, Fabrice; Moonen, Chrit

    2010-01-01

    Mild or severe renal arterial occlusion is a phenomenon occasionally observed in daily clinical practice, potentially leading to renal ischemia and a general impairment of renal function. Secondly, closing the blood flow to the kidneys can also occur during kidney transplantation procedures. However, the exact physiological effects of these conditions on renal blood perfusion as well as the renal oxygen handling are poorly understood. The objectives of this study were therefore to measure the lateral changes of renal blood perfusion in rats subjected to transient unilateral arterial occlusion (RAS), and in addition, to measure the consequences on the intrarenal oxygenation. Experimental studies were performed using sixteen adolescent rats. The left renal artery was exposed through a flank incision and acute RAS for 45 min was achieved by placing a ligature around the renal artery. MRI was performed 3 days after the surgical procedure, where a blood oxygenation sensitive sequence (BOLD MRI) was performed, followed by a perfusion-weighted imaging sequence using a single bolus of the iron-oxide nanoparticle Sinerem. The renal oxygenation of blood was indirectly measured by the BOLD-parameter R2 * , and perfusion measures include relative renal blood flow, relative renal blood volume and mean transit time. Histopathologic changes through the outer stripe of the outer medulla showing typical histopathologic findings of ischemia. This study demonstrated that rats with transient renal arterial stenosis (for 45 min) showed a reduction in intrarenal oxygenation and intrarenal blood flow three days after the surgical procedure. A decreased R2 * was measured within the ipsilateral medulla in parallel with a decreased medullary blood flow, is probably related to a lower reabsorption load within the ipsilateral kidney. MRI may therefore be a promising tool in long-term evaluation of RAS. (orig.)

  1. Renal hemodynamics and oxygenation in transient renal artery occluded rats evaluated with iron-oxide particles and oxygenation-sensitive imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pedersen, Michael [Aarhus Univ. Hospital (Denmark). MR Research Centre; Aarhus Univ. (Denmark). Inst. of Experimental Clinical Medicine; Univ. Victor Segalen Bordeaux 2 (France). Lab. Imagerie Moleculaire et Fonctionnelle: de la physiologie a la therapie CNRS UMR 5231; Laustsen, Christoffer [Aarhus Univ. Hospital (Denmark). MR Research Centre; Perot, Vincent; Grenier, Nicolas [Hopital Pellegrin, CHU Bordeaux (France). Service d' Imagerie Diagnostique et Therapeutique de l' Adulte; Basseau, Fabrice; Moonen, Chrit [Univ. Victor Segalen Bordeaux 2 (France). Lab. Imagerie Moleculaire et Fonctionnelle: de la physiologie a la therapie CNRS UMR 5231

    2010-07-01

    Mild or severe renal arterial occlusion is a phenomenon occasionally observed in daily clinical practice, potentially leading to renal ischemia and a general impairment of renal function. Secondly, closing the blood flow to the kidneys can also occur during kidney transplantation procedures. However, the exact physiological effects of these conditions on renal blood perfusion as well as the renal oxygen handling are poorly understood. The objectives of this study were therefore to measure the lateral changes of renal blood perfusion in rats subjected to transient unilateral arterial occlusion (RAS), and in addition, to measure the consequences on the intrarenal oxygenation. Experimental studies were performed using sixteen adolescent rats. The left renal artery was exposed through a flank incision and acute RAS for 45 min was achieved by placing a ligature around the renal artery. MRI was performed 3 days after the surgical procedure, where a blood oxygenation sensitive sequence (BOLD MRI) was performed, followed by a perfusion-weighted imaging sequence using a single bolus of the iron-oxide nanoparticle Sinerem. The renal oxygenation of blood was indirectly measured by the BOLD-parameter R2{sup *}, and perfusion measures include relative renal blood flow, relative renal blood volume and mean transit time. Histopathologic changes through the outer stripe of the outer medulla showing typical histopathologic findings of ischemia. This study demonstrated that rats with transient renal arterial stenosis (for 45 min) showed a reduction in intrarenal oxygenation and intrarenal blood flow three days after the surgical procedure. A decreased R2{sup *} was measured within the ipsilateral medulla in parallel with a decreased medullary blood flow, is probably related to a lower reabsorption load within the ipsilateral kidney. MRI may therefore be a promising tool in long-term evaluation of RAS. (orig.)

  2. Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review.

    Science.gov (United States)

    van Brussel, Peter M; van de Hoef, Tim P; de Winter, Robbert J; Vogt, Liffert; van den Born, Bert-Jan

    2017-05-22

    Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional coronary lesions, hyperemic measurements have earned a place in daily practice for clinical decision making, allowing discrimination between solitary coronary lesions and diffuse microvascular disease. Next to differences in clinical characteristics, the selection of renal arteries suitable for intervention is currently on the basis of anatomic grading of the stenosis by angiography rather than functional assessment under hyperemia. It is conceivable that, like the coronary circulation, functional measurements may better predict therapeutic efficacy of percutaneous transluminal renal angioplasty with stent placement. In this systematic review, the authors evaluate the available clinical evidence on the optimal hyperemic agents to induce intrarenal hyperemia, their association with anatomic grading, and their predictive value for treatment effects. In addition, the potential value of combined pressure and flow measurements to discriminate macrovascular from microvascular disease is discussed. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Bilateral renal artery variation

    OpenAIRE

    Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan

    2014-01-01

    Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

  4. The Effects of Renal Denervation on Renal Hemodynamics and Renal Vasculature in a Porcine Model.

    Directory of Open Access Journals (Sweden)

    Willemien L Verloop

    Full Text Available Recently, the efficacy of renal denervation (RDN has been debated. It is discussed whether RDN is able to adequately target the renal nerves.We aimed to investigate how effective RDN was by means of functional hemodynamic measurements and nerve damage on histology.We performed hemodynamic measurements in both renal arteries of healthy pigs using a Doppler flow and pressure wire. Subsequently unilateral denervation was performed, followed by repeated bilateral hemodynamic measurements. Pigs were terminated directly after RDN or were followed for 3 weeks or 3 months after the procedure. After termination, both treated and control arteries were prepared for histology to evaluate vascular damage and nerve damage. Directly after RDN, resting renal blood flow tended to increase by 29±67% (P = 0.01. In contrast, renal resistance reserve increased from 1.74 (1.28 to 1.88 (1.17 (P = 0.02 during follow-up. Vascular histopathology showed that most nerves around the treated arteries were located outside the lesion areas (8±7 out of 55±25 (14% nerves per pig were observed within a lesion area. Subsequently, a correlation was noted between a more impaired adventitia and a reduction in renal resistance reserve (β: -0.33; P = 0.05 at three weeks of follow-up.Only a small minority of renal nerves was targeted after RDN. Furthermore, more severe adventitial damage was related to a reduction in renal resistance in the treated arteries at follow-up. These hemodynamic and histological observations may indicate that RDN did not sufficiently target the renal nerves. Potentially, this may explain the significant spread in the response after RDN.

  5. The Effects of Renal Denervation on Renal Hemodynamics and Renal Vasculature in a Porcine Model

    Science.gov (United States)

    Verloop, Willemien L.; Hubens, Lisette E. G.; Spiering, Wilko; Doevendans, Pieter A.; Goldschmeding, Roel; Bleys, Ronald L. A. W.; Voskuil, Michiel

    2015-01-01

    Rationale Recently, the efficacy of renal denervation (RDN) has been debated. It is discussed whether RDN is able to adequately target the renal nerves. Objective We aimed to investigate how effective RDN was by means of functional hemodynamic measurements and nerve damage on histology. Methods and Results We performed hemodynamic measurements in both renal arteries of healthy pigs using a Doppler flow and pressure wire. Subsequently unilateral denervation was performed, followed by repeated bilateral hemodynamic measurements. Pigs were terminated directly after RDN or were followed for 3 weeks or 3 months after the procedure. After termination, both treated and control arteries were prepared for histology to evaluate vascular damage and nerve damage. Directly after RDN, resting renal blood flow tended to increase by 29±67% (P = 0.01). In contrast, renal resistance reserve increased from 1.74 (1.28) to 1.88 (1.17) (P = 0.02) during follow-up. Vascular histopathology showed that most nerves around the treated arteries were located outside the lesion areas (8±7 out of 55±25 (14%) nerves per pig were observed within a lesion area). Subsequently, a correlation was noted between a more impaired adventitia and a reduction in renal resistance reserve (β: -0.33; P = 0.05) at three weeks of follow-up. Conclusion Only a small minority of renal nerves was targeted after RDN. Furthermore, more severe adventitial damage was related to a reduction in renal resistance in the treated arteries at follow-up. These hemodynamic and histological observations may indicate that RDN did not sufficiently target the renal nerves. Potentially, this may explain the significant spread in the response after RDN. PMID:26587981

  6. BILATERAL DUPLICATION OF RENAL ARTERIES

    OpenAIRE

    Prajkta A Thete; Mehera Bhoir; M.V.Ambiye

    2014-01-01

    Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, su...

  7. Renal artery stenosis

    International Nuclear Information System (INIS)

    Desberg, A.; Paushter, D.M.; Lammert, G.K.; Hale, J.; Troy, R.; Novic, A.; Nally, J. Jr.

    1989-01-01

    Renal artery disease is a potentially correctable cause of hypertension. Previous studies have suggested the utility of duplex sonography in accurately detecting and grading the severity of renal artery stenosis. The purpose of this paper is to evaluate color flow Doppler for this use. Forty-three kidneys were examined by color-flow Doppler and conventional duplex sampling in patients with suspected renovascular hypertension or those undergoing aortography for unrelated reasons. Doppler tracings were obtained from the renal arteries and aorta with calculation of the renal aortic ratio (RAR) and resistive index (RI). Results of Doppler sampling with color flow guidance were compared with aortograms in a blinded fashion

  8. Bilateral triple renal arteries

    International Nuclear Information System (INIS)

    Pestemalci, Turan; Yildiz, Yusuf Zeki; Yildirim, Mehmet; Mavi, Ayfer; Gumusburun, Erdem

    2009-01-01

    Knowledge of the variations of the renal artery has grown in importance with increasing numbers of renal transplants, vascular reconstructions and various surgical and radio logic techniques being performed in recent years. We report the presence of bilateral triple renal arteries, discovered on routine dissection of a male cadaver. On the right side, one additional renal artery originated from the abdominal aorta (distributed to superior pole of the kidney) and one other originated from the right common iliac artery (distributed to lower pole of the kidney). On the left side, both additional renal arteries originated from the abdominal aorta. Our observation has been compared with variations described in the literature and their clinical importance has been emphasized. (author)

  9. Renal Branch Artery Stenosis

    DEFF Research Database (Denmark)

    Andersson, Zarah; Thisted, Ebbe; Andersen, Ulrik Bjørn

    2017-01-01

    Renovascular hypertension is a common cause of pediatric hypertension. In the fraction of cases that are unrelated to syndromes such as neurofibromatosis, patients with a solitary stenosis on a branch of the renal artery are common and can be diagnostically challenging. Imaging techniques...... that perform well in the diagnosis of main renal artery stenosis may fall short when it comes to branch artery stenosis. We report 2 cases that illustrate these difficulties and show that a branch artery stenosis may be overlooked even by the gold standard method, renal angiography....

  10. Renal artery stenosis.

    Science.gov (United States)

    Tafur-Soto, Jose David; White, Christopher J

    2015-02-01

    Atherosclerotic renal artery stenosis (RAS) is the single largest cause of secondary hypertension; it is associated with progressive renal insufficiency and causes cardiovascular complications such as refractory heart failure and flash pulmonary edema. Medical therapy, including risk factor modification, renin-angiotensin-aldosterone system antagonists, lipid-lowering agents, and antiplatelet therapy, is advised in all patients. Patients with uncontrolled renovascular hypertension despite optimal medical therapy, ischemic nephropathy, and cardiac destabilization syndromes who have severe RAS are likely to benefit from renal artery revascularization. Screening for RAS can be done with Doppler ultrasonography, CT angiography, and magnetic resonance angiography. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Hemodynamic significance of internal carotid artery disease

    DEFF Research Database (Denmark)

    Schroeder, T

    1988-01-01

    Neurologic symptoms in the region of an internal carotid artery stenosis are considered to be embolic in most instances. Only in a subgroup has carotid occlusive disease with impairment of the collateral supply, caused a state of hemodynamic failure with marked reduction of perfusion pressure. Th...

  12. Renal functional reserve and renal hemodynamics in hypertensive patients.

    Science.gov (United States)

    Gaipov, Abduzhappar; Solak, Yalcin; Zhampeissov, Nurlan; Dzholdasbekova, Aliya; Popova, Nadezhda; Molnar, Miklos Z; Tuganbekova, Saltanat; Iskandirova, Elmira

    2016-10-01

    The renal functional reserve (RFR) is the ability of the kidneys to increase renal plasma flow and glomerular filtration rate (GFR) in response to protein intake. It is a measure of functional and anatomic integrity of nephrons. It is not known what relation between RFR and kidney Doppler parameters. We aimed to study the relation between the RFR and renal hemodynamic parameters in hypertensive patients with and without nephropathy who had normal kidney function. Twenty-four hypertensive subjects with nephropathy (HTN-n, n = 10) and hypertension without nephropathy (HTN, n = 14) were included in the study. Control group included 11 healthy subjects. Baseline GFR (GFR1) and GFR after intake of egg protein 1 mg/kg of body weight were determined (GFR2). RFR was calculated by the following formula: (GFR2-GFR1)/GFR1 × 100%. Doppler ultrasonography was performed. Arterial blood pressure (BP), body mass index (BMI), and estimated GFR were also recorded. HTN and HTN-n groups had impaired levels of RFR compared with controls (p < 0.05), significantly decreased value of flow velocity parameters (Vmax, Vmin), and increased RRI compared with controls. There was significant negative correlation of RFR with blood pressure levels (sBP, r = -0.435, p = 0.009; dBP, r = -0.504, p = 0.002), RRI (r = -0.456, p = 0.008), micro albuminuria (MAU, r = -0.366, p = 0.031) and positive correlation with Vmax and Vmin (r = 0.556, p = 0.001 and r = 0.643, respectively, p < 0.001). Linear regression showed that RRI and MAU were independent predictors of decreased RFR. RFR is lower in hypertensive patients despite near-normal level of kidney function and is related to particular level of BP. RRI and MAU were independent predictors of decreased RFR.

  13. Hemodynamic significance of internal carotid artery disease

    DEFF Research Database (Denmark)

    Schroeder, T

    1988-01-01

    Neurologic symptoms in the region of an internal carotid artery stenosis are considered to be embolic in most instances. Only in a subgroup has carotid occlusive disease with impairment of the collateral supply, caused a state of hemodynamic failure with marked reduction of perfusion pressure...... stenosis. This is considered a result of chronic low perfusion pressure with subsequent loss of autoregulation, and autoregulatory control is first regained after some days.(ABSTRACT TRUNCATED AT 400 WORDS)...

  14. Mechanisms controlling renal hemodynamics and electrolyte excretion during amino acids

    International Nuclear Information System (INIS)

    Woods, L.L.; Mizelle, H.L.; Montani, J.P.; Hall, J.E.

    1986-01-01

    Our purpose was to investigate the mechanisms by which increased plasma amino acids elevate renal blood flow (RBF) and glomerular filtration rate (GFR). Since transport of amino acids and Na + is linked in the proximal tubule, the authors hypothesized that increased amino acids might stimulate proximal tubular Na + reabsorption (PR/sub Na/) and thus increase RBF and GFR by a macula densa feedback mechanism. A solution of four amino acids (Ala, Ser, Gly, Pro) was infused intravenously into anesthetized dogs with normal kidneys (NK) and with kidneys in which the tubuloglomerular feedback mechanism was blunted by lowering renal artery pressure (LPK) or blocked by making the kidneys nonfiltering (NFK). In NK, RBF and GFR increased by 35 +/- 4% and 30 +/- 7% after 90 min of amino acid infusion, while PR/sub Na/ (estimated from lithium clearance) and O 2 consumption increased by 31 +/- 5% and 29 +/- 5% and distal Na + delivery remained relatively constant. Autoregulation of RBF and GFR in response to step deceases in renal artery pressure was impaired during amino acids in NK. The hemodynamic responses to amino acids were abolished in LPK and NFK. Infusion of the nonmetabolized α-aminoisobutyric acid into NK produced changes in renal hemodynamics that were similar to the responses observed with the four metabolizable amino acids. These data are consistent with the hypothesis that elevation of plasma amino acids increases RBF and GFR by a mechanism that requires an intact macula densa feedback. Metabolism of the amino acids does not appear to be necessary for these changes to occur

  15. Mechanisms controlling renal hemodynamics and electrolyte excretion during amino acids

    Energy Technology Data Exchange (ETDEWEB)

    Woods, L.L.; Mizelle, H.L.; Montani, J.P.; Hall, J.E.

    1986-08-01

    Our purpose was to investigate the mechanisms by which increased plasma amino acids elevate renal blood flow (RBF) and glomerular filtration rate (GFR). Since transport of amino acids and Na is linked in the proximal tubule, the authors hypothesized that increased amino acids might stimulate proximal tubular Na reabsorption (PR/sub Na/) and thus increase RBF and GFR by a macula densa feedback mechanism. A solution of four amino acids (Ala, Ser, Gly, Pro) was infused intravenously into anesthetized dogs with normal kidneys (NK) and with kidneys in which the tubuloglomerular feedback mechanism was blunted by lowering renal artery pressure (LPK) or blocked by making the kidneys nonfiltering (NFK). In NK, RBF and GFR increased by 35 +/- 4% and 30 +/- 7% after 90 min of amino acid infusion, while PR/sub Na/ (estimated from lithium clearance) and O2 consumption increased by 31 +/- 5% and 29 +/- 5% and distal Na delivery remained relatively constant. Autoregulation of RBF and GFR in response to step deceases in renal artery pressure was impaired during amino acids in NK. The hemodynamic responses to amino acids were abolished in LPK and NFK. Infusion of the nonmetabolized -aminoisobutyric acid into NK produced changes in renal hemodynamics that were similar to the responses observed with the four metabolizable amino acids. These data are consistent with the hypothesis that elevation of plasma amino acids increases RBF and GFR by a mechanism that requires an intact macula densa feedback. Metabolism of the amino acids does not appear to be necessary for these changes to occur.

  16. Renal hemodynamic response to L-dopa during acute renal failure in man

    International Nuclear Information System (INIS)

    Zech, P.; Collard, M.; Guey, A.; Plantier, J.; Bernard, M.; Berthoux, F.; Pinet, A.; Traeger, J.

    1975-01-01

    Twelve patients with acute renal failure underwent L.dopa infusion into a renal artery and 133 Xenon wash-out recordings before and during the infusion. Urine volume and sodium output were also compared during two 24 hours periods, before and after the procedure. Hemodynamic data were compared with data obtained from a matched group of patients receiving Furosemide (8 patients) in place of L.dopa. Only L.dopa infusion significantly increased outer cortical distribution. No blood flow change could be demonstrated in any component nor did the drug improve unitary excretion or the general course of the disease. Control data shows that reduced cortical distribution is the most consistent feature of acute renal failure, so that L.dopa does partially improve intrarenal hemodynamics in this condition. The failure of the drug to restore kidney function may be explained by the following reasons: inability of the agent to restore a normal wash-out pattern: involvment of non-hemodynamic factors, as suggested by comparing similar wash-out improvements after L.dopa in acute glomerulonephritis and in reversible acute renal failure [fr

  17. Renal hemodynamic response to L-dopa during acute renal failure in man

    Energy Technology Data Exchange (ETDEWEB)

    Zech, P; Collard, M; Guey, A; Plantier, J; Bernard, M; Berthoux, F; Pinet, A; Traeger, J [Hopital Edouard-Herriot, 69 - Lyon (France)

    1975-12-20

    Twelve patients with acute renal failure underwent L-dopa infusion into a renal artery and /sup 133/Xenon wash-out recordings before and during the infusion. Urine volume and sodium output were also compared during two 24 hours periods, before and after the procedure. Hemodynamic data were compared with data obtained from a matched group of patients receiving Furosemide (8 patients) in place of L-dopa. Only L-dopa infusion significantly increased outer cortical distribution. No blood flow change could be demonstrated in any component nor did the drug improve unitary excretion or the general course of the disease. Control data shows that reduced cortical distribution is the most consistent feature of acute renal failure, so that L-dopa does partially improve intrarenal hemodynamics in this condition. The failure of the drug to restore kidney function may be explained by the following reasons: inability of the agent to restore a normal wash-out pattern: involvment of non-hemodynamic factors, as suggested by comparing similar wash-out improvements after L-dopa in acute glomerulonephritis and in reversible acute renal failure.

  18. Apparent diffusion coefficient of renal parenchyma and color Doppler ultrasound of intrarenal arteries in patients with cirrhosis related renal dysfunction

    Directory of Open Access Journals (Sweden)

    Mohamed M Hefeda

    2014-12-01

    Conclusion: Liver cirrhosis, even in the presence of refractory ascites, did not affect the ADC value of renal parenchyma, however ADC value is affected in renal parenchyma of patients with hepato-renal syndrome. Duplex-Doppler ultrasound of intrarenal arteries enables the early detection of renal hemodynamic disturbances in patients with liver cirrhosis.

  19. Effects of adenosine infusion into renal interstitium on renal hemodynamics

    International Nuclear Information System (INIS)

    Pawlowska, D.; Granger, J.P.; Knox, F.G.

    1987-01-01

    This study was designed to investigate the hemodynamic effects of exogenous adenosine in the interstitium of the rat kidney. Adenosine or its analogues were infused into the renal interstitium by means of chronically implanted capsules. In fusion of adenosine decreased glomerular filtration rate (GFR) from 0.81 +/- 0.06 to 0.37 +/- 0.06 ml/min while having no effect on renal blood flow (RBF). The metabolically stable analogue, 2-chloradenosine (2-ClAdo), decreased GFR from 0.73 +/- 0.07 to 021 +/- 0.06 ml/min. Interstitial infusion of theophylline, an adenosine receptor antagonist, completely abolished the effects of adenosine and 2-ClAdo on GFR. The distribution of adenosine, when infused into the renal interstitium, was determined using radiolabeled 5'-(N-ethyl)-carboxamidoadenosine (NECA), a metabolically stable adenosine agonist. After continuous infusion, [ 3 H]NECA was distributed throughout the kidney. The effects of NECA to reduce GFR were similar to those of adenosine and 2-ClAdo. They conclude that increased levels of adenosine in the renal interstitium markedly decrease GFR without affecting RBF in steady-state conditions. The marked effects of adenosine agonists during their infusion into the renal interstitium and the complete blockade of these effects by theophylline suggest an extracellular action of adenosine

  20. Testicular artery arising from an aberrant right renal artery | Suluba ...

    African Journals Online (AJOL)

    This case report we discovered the rare variation of the origin of the right testicular artery arising from the right aberrant renal artery with double renal artery irrigating both left and right kidneys. These variations in the testicular arteries and renal arteries have implication to surgical procedures such as orchidopexy repair for ...

  1. Fibromuscular dysplasia of renal arteries

    International Nuclear Information System (INIS)

    Akhtar, N.; Ahmed, T.M.

    2007-01-01

    This case reports a young child having uncontrolled hypertension, resulting from bilateral renal artery stenosis due to fibromuscular dysplasia presenting with abdominal pain, headache and visual disturbance. Diagnostic features and management is discussed. (author)

  2. Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease

    Science.gov (United States)

    Fernandes, Sheila Marques; Martins, Daniel Malisani; da Fonseca, Cassiane Dezoti; Watanabe, Mirian; Vattimo, Maria de Fátima Fernandes

    2016-01-01

    Iodinated contrast (IC) is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI). Chronic kidney disease (CKD) and chronic hyperglycemia (CH) are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH); Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL) and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance) were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI. PMID:27034930

  3. Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Sheila Marques Fernandes

    2016-01-01

    Full Text Available Iodinated contrast (IC is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI. Chronic kidney disease (CKD and chronic hyperglycemia (CH are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH; Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI.

  4. Assessment of hemodynamic changes in patients with renal artery stenosis by means of the cine MR phase-contrast technique; Einstufung haemodynamischer Veraenderungen bei Nierenarterienstenosen mittels MR-Cine-Phasenkontrastflussmessungen

    Energy Technology Data Exchange (ETDEWEB)

    Schoenberg, S.O.; Knopp, M.V.; Bock, M.; Essig, M.; Hawighorst, H.; Zuna, I.; Schad, L.; Kaick, G. van [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie; Kallinowski, F.; Allenberg, J.R. [Chirurgische Universitaetsklinik, Heidelberg (Germany). Sektion Gefaesschirurgie; Just, A. [Heidelberg Univ. (Germany). 1. Physiologisches Inst.

    1997-08-01

    Purpose: To evaluate the use of high-temporal resolution cine MR phase-contrast flow measurements for assessment of flow dynamics in renal artery stenosis (RAS). Material and methods: In a dog model, cine MR flow measurements were validated by comparing the MR flow data to an invasive transit-time ultrasound reference technique for different degrees of RAS. Cardiac-gated MR flow curves were recorded in 56 renal arteries of 28 patients with a temporal resolution of at least 32 ms. In all cases RAS was confirmed by digital subtraction angiography (DSA). Abnormalities of flow dynamics were assessed in the calculated flow curves using the MR parameters mean flow, maximum velocity, and time to systolic maximum. Results: By means of the MR blood flow paremeters high-grade stenoses (>50%, n=23) were detected with sensitivity of 100% and specificity of 94% with reference to DSA. The overall differentiation between stenoses (n=37) and non-stenosed vessels (n=19) revealed a sensitivity of 87% and a specificity of 100%. Conclusion: Analysis of cardiac-gated MR flow curves provides a non-invasive method to assess the hemodynamic significance of RAS and thus allows a functional evaluation in relation to the morphologic characteristics of the stenosis. (orig.) [Deutsch] Ziel der Untersuchung war die Beurteilung der Haemodynamik bei Nierenarterienstenosen mittels Cine-MR-Phasenkontrastflussmessungen. In einem Hundemodell wurde die Cine-MR-Flussmessung validiert, indem fuer unterschiedliche Stenosegrade Vergleichsmessungen mit einer invasiven Transitzeit-Ultraschallreferenztechnik durchgefuehrt wurden. EKG-getriggerte MR-Flusskurven wurden bei 28 Patienten in 56 Nierenarterien mit einer Zeitaufloesung von mindestens 32 ms aufgenommen. Alle Nierenarterienstenosen wurden mittels digitaler Subtraktionsangiographie gesichert. Stoerungen in der renalen Haemodynamik wurden anhand der berechneten MR-Flusskurven mit Hilfe der Parameter `Mittelfluss, `maximale Geschwindigkeit` und `Zeit

  5. Spiral CT angiography of renal arteries: comparison with angiography

    International Nuclear Information System (INIS)

    Wittenberg, G.; Kenn, W.; Tschammler, A.; Sandstede, J.; Hahn, D.

    1999-01-01

    A prospective study was carried out to determine the accuracy of spiral CT angiography (CTA) in the detection of renal artery stenosis (RAS). Eighty-two patients with arterial hypertension underwent CTA and digital subtraction angiography (DSA) to exclude RAS. For CTA a contrast medium bolus of 100-150 ml (flow rate 3 ml/s) was injected. A 24 or 40 s CTA was started at the origin of the superior mesenteric artery after a delay time determined by test bolus injection (collimation = 2 mm, pitch = 1/1.5). For stenosis detection transverse images supported by maximum intensity projections (MIP) or multiplanar reconstruction projections were used. Of 197 renal arteries examined (including 33 accessory arteries), 34 RAS were visualized using DSA. With CTA, one hemodynamic RAS was missed and one additional hemodynamic RAS was found. Sensitivity/specificity was calculated to be 94 %/98 %. For hemodynamically relevant RAS (> 50 %) the sensitivity/specificity was 96 %/99 %. CTA additionally depicted five adrenal masses. The high accuracy rate of RAS detection thus allows the use of CTA as a screening method in patients with arterial hypertension to exclude a renovascular cause. (orig.)

  6. Hemodynamics Modeling and Simulation of Anterior Communicating Artery Aneurysms

    Directory of Open Access Journals (Sweden)

    Jianjun Li

    2014-07-01

    Full Text Available It is a general agreement that hemodynamics plays very important role in the initiation, growth, and rupture of cerebral aneurysms and hemodynamics in the anterior communicating artery aneurysms is considered the most complex in all cerebral aneurysms and it is difficult to find some reasonable relationship between the hemodynamics parameters and the rupture risk. In this paper, the 3D geometries of four anterior communicating artery aneurysms were generated from the CTA data and the computational models with bilateral feeding arteries for the four aneurysms were constructed. The blood flow was simulated by computational fluid dynamics software and the hemodynamics parameters such as velocity, wall shear stress, and oscillatory shear index were calculated. The following results were observed: one of the four models only needs the left feeding artery; the max normalized wall shear stress locates at the aneurysmal neck of the largest aneurysm; the max oscillatory shear index locates at the aneurysmal sac of the largest aneurysm. The conclusion was drawn that the anterior communicating artery aneurysm has higher rupture risk from the hemodynamics viewpoint if the max wall shear stress locates at the neck and the max oscillatory shear index locates at the dome.

  7. Early evaluation of renal hemodynamic alterations in type I diabetes mellitus with duplex ultrasound

    Directory of Open Access Journals (Sweden)

    Saif Aasem

    2010-01-01

    Full Text Available To evaluate the role of renal duplex ultrasonography in the detection of early alte-ration of renal blood flow in type I diabetic patients, we studied with duplex ultrasound 32 patients with type I diabetes mellitus (19 males, 13 females, age range 8-19 years and 35 age and sex-matched controls. The resistivity indices (RIs and pulsatility indices (PIs of the main renal as well as intra-renal arteries were calculated. Compared with the healthy control subjects, diabetic patients had significantly higher resistivity indices (RIs in the intrarenal (segmental, arcuate and interlobar ar-teries (P= 0.001. The study, also revealed a significantly positive correlation between the RIs in the intrarenal arteries in diabetics and the albumin/creatinine ratio (r= 0.54, 0.52 and 0.51 respectively, glycated hemoglobin (r= 0.61, 0.59 and 0.63 respectively, as well as the estimated GFR (e-GFR (r= 0.53, 0.51 and 0.57 respectively. We conclude that the current study documented early intra-renal hemodynamic alterations in the form of pathologically elevated intrarenal RIs. This denotes the potential usefulness of duplex evaluation of the intrarenal arteries, as a noninvasive procedure, for monitoring type 1 diabetic patients to predict those at risk of diabetic nephropathy.

  8. Hemodynamic and neurochemical determinates of renal function in chronic heart failure.

    Science.gov (United States)

    Gilbert, Cameron; Cherney, David Z I; Parker, Andrea B; Mak, Susanna; Floras, John S; Al-Hesayen, Abdul; Parker, John D

    2016-01-15

    Abnormal renal function is common in acute and chronic congestive heart failure (CHF) and is related to the severity of congestion. However, treatment of congestion often leads to worsening renal function. Our objective was to explore basal determinants of renal function and their response to hemodynamic interventions. Thirty-seven patients without CHF and 59 patients with chronic CHF (ejection fraction; 23 ± 8%) underwent right heart catheterization, measurements of glomerular filtration rate (GFR; inulin) and renal plasma flow (RPF; para-aminohippurate), and radiotracer estimates of renal sympathetic activity. A subset (26 without, 36 with CHF) underwent acute pharmacological intervention with dobutamine or nitroprusside. We explored the relationship between baseline and drug-induced hemodynamic changes and changes in renal function. In CHF, there was an inverse relationship among right atrial mean pressure (RAM) pressure, RPF, and GFR. By contrast, mean arterial pressure (MAP), cardiac index (CI), and measures of renal sympathetic activity were not significant predictors. In those with CHF there was also an inverse relationship among the drug-induced changes in RAM as well as pulmonary artery mean pressure and the change in GFR. Changes in MAP and CI did not predict the change in GFR in those with CHF. Baseline values and changes in RAM pressure did not correlate with GFR in those without CHF. In the CHF group there was a positive correlation between RAM pressure and renal sympathetic activity. There was also an inverse relationship among RAM pressure, GFR, and RPF in patients with chronic CHF. The observation that acute reductions in RAM pressure is associated with an increase in GFR in patients with CHF has important clinical implications. Copyright © 2016 the American Physiological Society.

  9. Basilar artery angulation and vertigo due to the hemodynamic effect of dominant vertebral artery.

    Science.gov (United States)

    Cosar, Murat; Yaman, Mehmet; Eser, Olcay; Songur, Ahmet; Ozen, Oguz A

    2008-01-01

    Vertebral arteries form the basilar artery at the pontobulbar junction. The vertebral artery may have dominancy in one of them. The branches of basilar arteries supply blood for the vestibular nuclei and its connections. Vertigo is seen generally in the upper middle aged patients. Vertigo can be observed in dolichoectasia of basilar artery such as angulation and elongation, because of the diminished blood supply and changed hemodynamic factors of vestibular nuclei and its connections. We hypothesized that angulation or elongation of basilar artery can be estimated according to the unilateral vertebral artery dominant hypertensive patients. The basilar artery can angulate from the dominant side of vertebral artery to the recessive side. These angulation and elongation can effect the hemodynamic factors in absence of growing collateral arteries. So, the vertigo attacks may occur in these patients.

  10. Dietary melatonin alters uterine artery hemodynamics in pregnant holstein heifers

    Science.gov (United States)

    The objective was to examine uterine artery hemodynamics and maternal serum profiles in pregnant heifers supplemented with dietary melatonin (MEL) or no supplementation (CON). In addition, melatonin receptor–mediated responses in steroid metabolism were examined using a bovine endometrial epithelial...

  11. Hemodynamics alter arterial low-density lipoprotein metabolism

    International Nuclear Information System (INIS)

    Warty, V.S.; Calvo, W.J.; Berceli, S.A.; Pham, S.M.; Durham, S.J.; Tanksale, S.K.; Klein, E.C.; Herman, I.M.; Borovetz, H.S.

    1989-01-01

    We have investigated the role of hemodynamic factors on low-density lipoprotein transport and metabolism in the intact arterial wall. Freshly excised canine carotid blood vessels were exposed to well-defined pulsatile flow in vitro for continuous periods up to 20 hours. We chose to impose the following hemodynamic conditions on our test carotid arteries: normotension, hypertension (at physiologic flow conditions), and hypertension coupled with elevated flow of canine serum perfusate. In several experiments the effect of endothelial denudation was examined in carotid arteries exposed to normotensive pulsatile flow. A trapped ligand method was used for quantitating low-density lipoprotein uptake and metabolism in the arterial wall. The distribution of both intact and degraded low-density lipoprotein fractions was determined from measurements of radiolabelled low-density lipoprotein activity within thin radial sections of perfused arteries. Our results suggest that both hypertensive hemodynamic simulations exacerbate the uptake of low-density lipoprotein within the arterial wall (by a factor of three to nine). The percentage of low-density lipoprotein that undergoes irreversible degradation falls from 41% under normotensive conditions to below 30% when hypertensive conditions are imposed, indicating that degradative processes are not proportionally elevated with the accelerated influx. A similar pattern is observed for deendothelialized vessels

  12. Interventional treatment of transplanted renal artery stenosis

    International Nuclear Information System (INIS)

    Zhou Haihong; Chen Weiguo; Lu Wei; Chen Yong; Yan Xinmin; Zhou Jianyong; Li Yanhao

    2002-01-01

    Purpose: To evaluate the clinical application of percutaneous transluminal renal artery angioplasty (PTRA) in the treatment of transplanted renal artery stenosis. Methods: Nine patients with transplanted renal artery stenosis were treated by PTRA with balloon catheter through the f amoral artery. Metal stent was placed in 3 patients out of 9. Results: Technical success was obtained in all procedures. In 7 patients normal blood pressure was restored and serum creatinine remarkably decreased. But anti-hypertension drugs were still needed in rest 2 patients. Conclusion: PTRA and stent implantation are useful and valuable method in the treatment of transplanted renal artery stenosis

  13. Mathematical modeling of renal hemodynamics in physiology and pathophysiology.

    Science.gov (United States)

    Sgouralis, Ioannis; Layton, Anita T

    2015-06-01

    In addition to the excretion of metabolic waste and toxin, the kidney plays an indispensable role in regulating the balance of water, electrolyte, acid-base, and blood pressure. For the kidney to maintain proper functions, hemodynamic control is crucial. In this review, we describe representative mathematical models that have been developed to better understand the kidney's autoregulatory processes. We consider mathematical models that simulate glomerular filtration, and renal blood flow regulation by means of the myogenic response and tubuloglomerular feedback. We discuss the extent to which these modeling efforts have expanded the understanding of renal functions in health and disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Duplex ultrasound for identifying renal artery stenosis

    DEFF Research Database (Denmark)

    Zachrisson, Karin; Herlitz, Hans; Lönn, Lars

    2017-01-01

    Background Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial trans...

  15. Renal Artery Stenosis (RAS) Case study

    International Nuclear Information System (INIS)

    Zaater, M.K.

    2012-01-01

    Renal Artery Stenosis (RAS), is one of the causes of secondary hypertension; there are many causes of renal artery stenosis, as atherosclerosis of the renal artery which account for 90% of cases of RAS; fibromuscular dysplasia accounts for 10% of RAS. Various causes of thrombophilia either due congenital causes or acquired causes and can lead to RAS. Our patient was presented by acute attack of epistaxis and hypertension. Angiography of the Renal Arteries,are showed no sign of renal artery stenosis. However, the right kidney showed upper pole infarction, and the left kidney showed evidence of functional lower pole renal artery stenosis, although there is no anatomical stenosis detected in angiography. Work up for the cause of thrombophilia did not help in the diagnosis, which may be due to an undiscovered cause of thrombophilia

  16. A study of the hemodynamics of anterior communicating artery aneurysms

    Science.gov (United States)

    Cebral, Juan R.; Castro, Marcelo A.; Putman, Christopher M.

    2006-03-01

    In this study, the effects of unequal physiologic flow conditions in the internal carotid arteries on the intra-aneurysmal hemodynamics of anterior communicating artery aneurysms were investigated. Patient-specific vascular computational fluid dynamics models of five cerebral aneurysms were constructed from bilateral 3D rotational angiography images. The aneurysmal hemodynamics was analyzed under a range of physiologic flow conditions including the effects of unequal mean flows and phase shifts between the flow waveforms of the left and right internal carotid arteries. A total of five simulations were performed for each patient, and unsteady wall shear stress (WSS) maps were created for each flow condition. Time dependent curves of average WSS magnitude over selected regions on the aneurysms were constructed and used to analyze the influence of the inflow conditions. It was found that mean flow imbalances in the feeding vessels tend to shift the regions of elevated WSS (flow impingement region) towards the dominating inflow jet and to change the magnitude of the WSS peaks. However, the overall qualitative appearance of the WSS distribution and velocity simulations is not substantially affected. In contrast, phase differences tend to increase the temporal complexity of the hemodynamic patterns and to destabilize the intra-aneurysmal flow pattern. However, these effects are less important when the A1 confluence is less symmetric, i.e. dominated by one of the A1 segments. Conditions affecting the flow characteristics in the parent arteries of cerebral aneurysms with more than one avenue of inflow should be incorporated into flow models.

  17. Renal sympathetic denervation: MDCT evaluation of the renal arteries.

    LENUS (Irish Health Repository)

    Hutchinson, Barry D

    2013-08-01

    Percutaneous transluminal renal sympathetic denervation is a new treatment of refractory systemic hypertension. The purpose of this study was to assess the clinical utility of MDCT to evaluate the anatomic configuration of the renal arteries in the context of renal sympathetic denervation.

  18. Endovascular Exclusion of Renal Artery Aneurysm

    International Nuclear Information System (INIS)

    Andersen, Poul Erik; Rohr, Nils

    2005-01-01

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90 o , but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable

  19. A Renal Perforating Artery Mistaken for Arterial Bleeding after Percutaneous Renal Biopsy: A Case Report

    International Nuclear Information System (INIS)

    Kim, Ye Lim; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min

    2009-01-01

    Perirenal hematoma after a renal biopsy is a common complication that usually resolves spontaneously, but this rarely requires transfusions or surgical/radiological intervention. We report here on a case of a renal perforating artery that was mistaken for renal arterial bleeding in a 53-year-old woman who was complicated with perirenal hematoma after undergoing a percutaneous renal biopsy. On the color and pulsed wave Doppler ultrasonography, linear blood flow was seen in the perirenal hematoma, which extended perpendicularly from the renal parenchyma into the perirenal space, and this linear blood flow exhibited an arterial pulse wave. On CT angiography, the renal perforating artery was demonstrated as a curvilinear vessel coursing tangentially to the renal margin and we decided that it was a pseudolesion caused by the renal perforating artery. A renal perforating artery may be mistaken for renal arterial bleeding after a percutaneous renal biopsy. A renal perforating artery and arterial bleeding can be differentiated by the location and shape seen on a color Doppler examination and the pulse waves characteristics

  20. A Renal Perforating Artery Mistaken for Arterial Bleeding after Percutaneous Renal Biopsy: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ye Lim; Lee, Chang Hee; Kim, Kyeong Ah; Park, Cheol Min [Korea University College of Medicine, Seoul (Korea, Republic of)

    2009-12-15

    Perirenal hematoma after a renal biopsy is a common complication that usually resolves spontaneously, but this rarely requires transfusions or surgical/radiological intervention. We report here on a case of a renal perforating artery that was mistaken for renal arterial bleeding in a 53-year-old woman who was complicated with perirenal hematoma after undergoing a percutaneous renal biopsy. On the color and pulsed wave Doppler ultrasonography, linear blood flow was seen in the perirenal hematoma, which extended perpendicularly from the renal parenchyma into the perirenal space, and this linear blood flow exhibited an arterial pulse wave. On CT angiography, the renal perforating artery was demonstrated as a curvilinear vessel coursing tangentially to the renal margin and we decided that it was a pseudolesion caused by the renal perforating artery. A renal perforating artery may be mistaken for renal arterial bleeding after a percutaneous renal biopsy. A renal perforating artery and arterial bleeding can be differentiated by the location and shape seen on a color Doppler examination and the pulse waves characteristics

  1. Diagnostics Of Renal Hemodynamics Disturbance In Children And Teenagers With Chronic Constipation, Encopresis And Their Correction

    Directory of Open Access Journals (Sweden)

    A.L. Malykh

    2009-12-01

    Full Text Available The article gives the detailed issue of results of complex inspection of 90 children and teenagers aged 4-17 with problems of chronic constipation, incontinence and encopresis. Ultrasonic screening has shown various pathology in the functional condition of arterial renal vessels. The method of biological feedback has been considered as prospective method of treatment excluding medication of bladder and small bowel dysfunction. The efficiency of the method was marked at combination of encopresis and incontinence. The purpose of the present research was the study of renal hemodynamics disturbances and working out methods of their correction. The examination included ultrasonic investigation, electromyography and uroflowmetry. The study of functional condition of anterior abdominal wall muscles and pelvic floor muscles was performed by means of «Miomed - 938». All patients received complex therapy on the basis of which the method of biological feedback was used

  2. Renal artery origins: best angiographic projection angles.

    Science.gov (United States)

    Verschuyl, E J; Kaatee, R; Beek, F J; Patel, N H; Fontaine, A B; Daly, C P; Coldwell, D M; Bush, W H; Mali, W P

    1997-10-01

    To determine the best projection angles for imaging the renal artery origins in profile. A mathematical model of the anatomy at the renal artery origins in the transverse plane was used to analyze the amount of aortic lumen that projects over the renal artery origins at various projection angles. Computed tomographic (CT) angiographic data about the location of 400 renal artery origins in 200 patients were statistically analyzed. In patients with an abdominal aortic diameter no larger than 3.0 cm, approximately 0.5 mm of the proximal part of the renal artery and origin may be hidden from view if there is a projection error of +/-10 degrees from the ideal image. A combination of anteroposterior and 20 degrees and 40 degrees left anterior oblique projections resulted in a 92% yield of images that adequately profiled the renal artery origins. Right anterior oblique projections resulted in the least useful images. An error in projection angle of +/-10 degrees is acceptable for angiographic imaging of the renal artery origins. Patients sex, site of interest (left or right artery), and local diameter of the abdominal aorta are important factors to consider.

  3. Hemodynamic study of cervical carotid arteries using DSA

    International Nuclear Information System (INIS)

    Kumashiro, Masayuki; Araki, Osamu; Matsunaga, Morio; Shigeyasu, Makio

    1986-01-01

    Although intravenous digital subtraction angiography (IVDSA) has been widely utilized as a means of morphological examination for the detection of intracranial or extracranial vascular lesions, it has thus for contributed little to quantitative assessment in hemodynamics. In the present study, a fundamental analysis of the hemodynamics on the cervical carotid artery was performed with a relative perfusion efficiency (Rath et al., 1979). This was not related to the measurement of time, such as the mean transit time, but was based on Sapirstein's principle. After the intravenous administration of the contrast material, dynamic DSA was performed using our equipment, Shimadzu DAR-100. After setting the region of interest in common carotid arteries on DSA images by means of a microdensitometer (Sakura PDS-15) combined with a computer (NEC ACOS-460), time-density curves were obtained on both sides. Thereafter, the RPE was calculated as a ratio of two integrals from the zero time to the earlier peak time of the time-density curves with respect to the time. The flow model with the hydro-dynamic system was used to detect the relationship between the RPEs and the ratios of the actual flows in the system. The results of this experiment showed a high correlation between the RPEs and the flows (r = 0.85, p < 0.001). In normal subjects (n = 28), the mean of the RPEs was 1.07 ± 0.27 (S.D.). The RPEs showed significantly lower values in the 5 patients with severe stenosis of the internal carotid artery (0.76 ± 0.15, p < 0.02), as well as even more significantly lower values in the 9 patients with a complete occlusion of the internal carotid artery (0.64 ± 0.19, p < 0.001). The RPE measurement with IVDSA has been shown to be useful for recognizing the cervical hemodynamic changes in patients with occlusive cervicovascular disease. (author)

  4. Arterial stiffness, central hemodynamics, and cardiovascular risk in hypertension

    Science.gov (United States)

    Palatini, Paolo; Casiglia, Edoardo; Gąsowski, Jerzy; Głuszek, Jerzy; Jankowski, Piotr; Narkiewicz, Krzysztof; Saladini, Francesca; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Van Bortel, Luc; Wojciechowska, Wiktoria; Kawecka-Jaszcz, Kalina

    2011-01-01

    This review summarizes several scientific contributions at the recent Satellite Symposium of the European Society of Hypertension, held in Milan, Italy. Arterial stiffening and its hemodynamic consequences can be easily and reliably measured using a range of noninvasive techniques. However, like blood pressure (BP) measurements, arterial stiffness should be measured carefully under standardized patient conditions. Carotid-femoral pulse wave velocity has been proposed as the gold standard for arterial stiffness measurement and is a well recognized predictor of adverse cardiovascular outcome. Systolic BP and pulse pressure in the ascending aorta may be lower than pressures measured in the upper limb, especially in young individuals. A number of studies suggest closer correlation of end-organ damage with central BP than with peripheral BP, and central BP may provide additional prognostic information regarding cardiovascular risk. Moreover, BP-lowering drugs can have differential effects on central aortic pressures and hemodynamics compared with brachial BP. This may explain the greater beneficial effect provided by newer antihypertensive drugs beyond peripheral BP reduction. Although many methodological problems still hinder the wide clinical application of parameters of arterial stiffness, these will likely contribute to cardiovascular assessment and management in future clinical practice. Each of the abovementioned parameters reflects a different characteristic of the atherosclerotic process, involving functional and/or morphological changes in the vessel wall. Therefore, acquiring simultaneous measurements of different parameters of vascular function and structure could theoretically enhance the power to improve risk stratification. Continuous technological effort is necessary to refine our methods of investigation in order to detect early arterial abnormalities. Arterial stiffness and its consequences represent the great challenge of the twenty-first century for

  5. Studies on diagnosis and treatment of renal artery stenosis

    NARCIS (Netherlands)

    P. Krijnen (Pieta)

    2004-01-01

    textabstractThis thesis describes studies on ~onosis and treatment of renal artery stenosis in patients with drug-resistant hypertension. In Chapter 1, the clinical problem of renal artery stenosis is discussed. Renal artery stenosis, a narrowing of the renal artery, is a potential cause of

  6. Renal vein oxygen saturation in renal artery stenosis

    DEFF Research Database (Denmark)

    Nielsen, K; Rehling, M; Henriksen, Jens Henrik Sahl

    1992-01-01

    Renal vein oxygen-saturation was measured in 56 patients with arterial hypertension and unilateral stenosis or occlusion of the renal artery. Oxygen-saturation in blood from the ischaemic kidney (84.4%, range 73-93%) was significantly higher than that from the 'normal' contralateral kidney (81...... than its blood flow. This is probably due to decreased filtration fraction and filtered sodium with subsequent reduction in absolute tubular re-absorption of sodium ions....

  7. Relationship between renal hemodynamic status and aging in patients without diabetes evaluated by renal Doppler ultrasonography.

    Science.gov (United States)

    Kawai, Tatsuo; Kamide, Kei; Onishi, Miyuki; Hongyo, Kazuhiro; Yamamoto-Hanasaki, Hiroko; Oguro, Ryosuke; Maekawa, Yoshihiro; Yamamoto, Koichi; Takeya, Yasushi; Sugimoto, Ken; Ohishi, Mitsuru; Rakugi, Hiromi

    2012-10-01

    Aging is well known as one of the major causes of a reduced glomerular filtration rate (GFR). The resistive index (RI) measured by renal Doppler ultrasonography (RDU) is thought to be a good indicator of renal vascular resistance induced by arteriosclerosis. In this study, we investigated whether RI could be used to evaluate the pathogenesis of renal damage or the mechanisms of reduction of renal function by aging. We investigated the correlation between RI and multiple clinical parameters and the influence of aging on the renal hemodynamic status of 194 in-patients (mean age 66.2 years) who underwent RDU at our hospital between February 2009 and July 2010. RI was significantly correlated with the age, estimated GFR (eGFR), diastolic blood pressure, pulse pressure, and degree of albuminuria. Subjects aged ≥75 years showed a significantly higher correlation coefficient between eGFR and RI. RI showed a stronger correlation with age in subjects aged ≥75 years compared to eGFR. The present study showed that renal vascular resistance and intra-renal arteriosclerosis had a greater impact on renal function in older than younger subjects, reflecting the possible mechanisms of renal function reduction due to aging.

  8. Hemodynamic effects of innominate artery occlusive disease on anterior cerebral artery.

    Science.gov (United States)

    Tan, Teng-Yeow; Lien, Li-Ming; Schminke, Ulf; Tesh, Paul; Reynolds, Patrick S; Tegeler, Charles H

    2002-01-01

    Stenoses of the innominate artery (IA) may affect flow conditions in the carotid arteries. However, alternating flow in ipsilateral anterior cerebral artery (ACA) due to IA stenosis is extremely rare. A 49-year-old woman who was evaluated for symptomatic cerebrovascular disease presented with right latent subclavian and right carotid system steal. Transcranial Doppler examination displayed systolic deceleration wave-forms in the right terminal internal carotid artery and alternating flow in the right ACA. Magnetic resonance angiography demonstrated tight stenosis of the right IA. For a thorough study of the hemodynamic effects of IA stenosis, a combination of duplex and transcranial Doppler examination is required.

  9. Angiographic Findings and Embolotherapy in Renal Arterial Trauma

    International Nuclear Information System (INIS)

    Sofocleous, Constantinos T.; Hinrichs, Clay; Hubbi, Basil; Brountzos, Elias; Kaul, Sanjeev; Kannarkat, George; Bahramipour, Philip; Barone, Alison; Contractor, Daniel G.; Shah, Tanmaya

    2005-01-01

    Purpose To evaluate the angiographic findings and embolotherapy in the management of traumatic renal arterial injury Methods This is a retrospective review of 22 patients with renal trauma who underwent arteriography and percutaneous embolization from December 1995 to January 2002. Medical records, imaging studies and procedural reports were reviewed to assess the type of injury, arteriographic findings and immediate embolization results. Long-term clinical outcome was obtained by communication with the trauma physicians and by clinical chart review.Results Arteriography was performed in 125 patients admitted to a State Trauma Center with suspected internal bleeding. Renal arterial injury was documented in 22 and was the result of a motor-vehicle accident (10), auto-pedestrian accident (1), gunshot (4) or stab wounds (6) and a fall (1). Percutaneous renal arterial embolization was undertaken in 22 of 125 (18%) patients to treat extravasation (11), arterial pedicle rupture (5), abnormal arteriovenous (3) or arteriocalyceal (2) communication and pseudoaneurysm (3). One of the pseudoaneurysms and one of the arteriovenous fistulae were found in addition to extravasation. All 22 patients (16 men, 6 women) were hemodynamically stable, or controlled during arteriography and embolotherapy. Selective and/or superselective embolization of the abnormal vessels was performed using coils in 9 patients, microcoils in 9 patients and Gelfoam pledgets in 3 patients. In one patient Gelfoam pledgets mixed with polyvinyl alcohol (PVA) particles were used for embolization. Immediate angiographic evidence of hemostasis was demonstrated in all cases. Two initial technical failures were treated with repeat arteriography and embolization. There was no procedure-related death. There was no non-target embolization. One episode of renal abscess after embolization was treated by nephrectomy and 3 patients underwent elective post-embolization nephrectomy to prevent infection. Follow-up ranged

  10. Interventional therapy of atherosclerotic renal artery occlusion

    International Nuclear Information System (INIS)

    Li Jian; Xu Ke; Xiao Liang

    2009-01-01

    Objective: To investigate the effectiveness of interventional therapy for the atherosclerotic renal artery occlusion (ARAO). Methods: During the period of June 2001-Dec. 2007, 16 patients with ARAO (total of 16 occluded arteries) underwent interventional managements, including percutaneous endovascular renal artery revascularization, balloon dilatation angioplasty and stent placement. Follow-up survey was made at regular intervals. The patent condition of the renal artery was evaluated with ultrasonography and digital subtraction angiography. The blood pressure and the renal function were determined and the data were statistically analyzed in order to assess the intermediate and long-term effect of the interventional therapy. Results: Of 16 patients, technical success was achieved in 15 (93.8%) and failure occurred in one. During a follow-up period of 9 - 24 months, 3 patients died. According to the data obtained at each patient's last follow-up survey, the hypertension fell to normal in 3 (25.0%), was improved in 7 (58.3%) and showed no marked change in 2 patients (16.7%), with a clinical efficacy of 83.3% (10 / 12). The renal function was improved in 2 (16.7%), stabilized in 6 (50%) and deteriorated in 4 patients (33.3%), with an effective rate of 66.7% (8 / 12). Conclusion: For the treatment of atherosclerotic renal artery occlusion, the interventional therapy carries high successful rate and can effectively lower the blood pressure level, in addition, it can also protect the renal function in a certain degree. (authors)

  11. Morphological and hemodynamic analysis of mirror posterior communicating artery aneurysms.

    Directory of Open Access Journals (Sweden)

    Jinyu Xu

    Full Text Available BACKGROUND AND PURPOSE: Hemodynamic factors are commonly believed to play an important role in the pathogenesis, progression, and rupture of cerebral aneurysms. In this study, we aimed to identify significant hemodynamic and morphological parameters that discriminate intracranial aneurysm rupture status using 3-dimensional-angiography and computational fluid dynamics technology. MATERIALS AND METHODS: 3D-DSA was performed in 8 patients with mirror posterior communicating artery aneurysms (Pcom-MANs. Each pair was divided into ruptured and unruptured groups. Five morphological and three hemodynamic parameters were evaluated for significance with respect to rupture. RESULTS: The normalized mean wall shear stress (WSS of the aneurysm sac in the ruptured group was significantly lower than that in the unruptured group (0.52±0.20 versus 0.81±0.21, P = .012. The percentage of the low WSS area in the ruptured group was higher than that in the unruptured group (4.11±4.66% versus 0.02±0.06%, P = .018. The AR was 1.04±0.21 in the ruptured group, which was significantly higher than 0.70±0.17 in the unruptured group (P = .012. By contrast, parameters that had no significant differences between the two groups were OSI (P = .674, aneurysm size (P = .327, size ratio (P = .779, vessel angle (P = 1.000 and aneurysm inclination angle (P = 1.000. CONCLUSIONS: Pcom-MANs may be a useful disease model to investigate possible causes of aneurysm rupture. The ruptured aneurysms manifested lower WSS, higher percentage of low WSS area, and higher AR, compared with the unruptured one. And hemodynamics is as important as morphology in discriminating aneurysm rupture status.

  12. Central Hemodynamics and Arterial Stiffness in Systemic Sclerosis.

    Science.gov (United States)

    Bartoloni, Elena; Pucci, Giacomo; Cannarile, Francesca; Battista, Francesca; Alunno, Alessia; Giuliani, Marco; Cafaro, Giacomo; Gerli, Roberto; Schillaci, Giuseppe

    2016-12-01

    Although microvascular disease is a hallmark of systemic sclerosis (SSc), a higher prevalence of macrovascular disease and a poorer related prognosis have been reported in SSc than in the general population. The simultaneous assessment of prognostically relevant functional properties of larger and smaller arteries, and their effects on central hemodynamics, has never been performed in SSc using the state-of-the-art techniques. Thirty-four women with SSc (aged 61±15 years, disease duration 17±12 years, and blood pressure 123/70±18/11 mm Hg) and 34 healthy women individually matched by age and mean arterial pressure underwent the determination of carotid-femoral (aortic) and carotid-radial (upper limb) pulse wave velocity (a direct measure of arterial stiffness), aortic augmentation (a measure of the contribution of reflected wave to central pulse pressure), and aortobrachial pulse pressure amplification (brachial/aortic pulse pressure) through applanation tonometry (SphygmoCor). Patients and controls did not differ by carotid-femoral or carotid-radial pulse wave velocity. Aortic augmentation index corrected for a heart rate of 75 bpm (AIx@75) was higher in women with SSc (30.9±16% versus 22.2±12%; P=0.012). Patients also had a lower aortobrachial amplification of pulse pressure (1.22±0.18 versus 1.33±0.25; P=0.041). SSc was an independent predictor of AIx@75 (direct) and pulse pressure amplification (inverse). Among patients, age, mean arterial pressure, and C-reactive protein independently predicted carotid-femoral pulse wave velocity. Age and mean arterial pressure were the only predictors of AIx@75. Women with SSc have increased aortic augmentation and decreased pulse pressure amplification (both measures of the contribution of reflected wave to central waveform) but no changes in aortic or upper limb arterial stiffness. Microvascular involvement occurs earlier than large artery stiffening in SSc. © 2016 American Heart Association, Inc.

  13. [Effect of complex sanatorium treatment including magnetotherapy on hemodynamics in patients with arterial hypertension].

    Science.gov (United States)

    Efremushkin, G G; Duruda, N V

    2003-01-01

    Forty nine patients with arterial hypertension of stage I-II received combined sanatorium treatment. Of them, 21 had adjuvant total magnetotherapy. All the patients were examined for parameters of central, cerebral hemodynamics and microcirculation. The adjuvant magnetotherapy produced a beneficial effect on hypertension: clinical symptoms attenuated, arterial pressure became more stable, hemodynamics improved, duration of hospitalization reduced, requirement in hypotensive drugs diminished.

  14. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors

    Directory of Open Access Journals (Sweden)

    Deirdre M Mooney

    2015-10-01

    Full Text Available Heart failure (HF is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.

  15. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors.

    Science.gov (United States)

    Mooney, Deirdre M; Fung, Erik; Doshi, Rahul N; Shavelle, David M

    2015-01-01

    Heart failure (HF) is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF) can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.

  16. Effects of a human recombinant alkaline phosphatase on renal hemodynamics, oxygenation and inflammation in two models of acute kidney injury

    Energy Technology Data Exchange (ETDEWEB)

    Peters, Esther, E-mail: esther.peters@radboudumc.nl [Department of Intensive Care Medicine, Radboud university medical center, PO Box 9101, Internal Mailbox 710, 6500 HB, Nijmegen (Netherlands); Department of Pharmacology and Toxicology, Radboud university medical center, PO Box 9101, Internal Mailbox 149, 6500 HB, Nijmegen (Netherlands); Ergin, Bülent, E-mail: b.ergin@amc.uva.nl [Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Kandil, Asli, E-mail: aslikandil@istanbul.edu.tr [Department of Biology, Faculty of Science, Istanbul University, PK 34134, Vezneciler, Istanbul (Turkey); Gurel-Gurevin, Ebru, E-mail: egurelgurevin@gmail.com [Department of Biology, Faculty of Science, Istanbul University, PK 34134, Vezneciler, Istanbul (Turkey); Elsas, Andrea van, E-mail: a.vanelsas@am-pharma.com [AM-Pharma, Rumpsterweg 6, 3981 AK, Bunnik (Netherlands); Masereeuw, Rosalinde, E-mail: r.masereeuw@uu.nl [Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, PO Box 80082, 3508 TB Utrecht (Netherlands); Pickkers, Peter, E-mail: peter.pickkers@radboudumc.nl [Department of Intensive Care Medicine, Radboud university medical center, PO Box 9101, Internal Mailbox 710, 6500 HB, Nijmegen (Netherlands); Ince, Can, E-mail: c.ince@amc.uva.nl [Department of Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)

    2016-12-15

    Two small clinical trials indicated that administration of bovine intestinal alkaline phosphatase (AP) improves renal function in critically ill patients with sepsis-associated acute kidney injury (AKI), for which the mechanism of action is not completely understood. Here, we investigated the effects of a newly developed human recombinant AP (recAP) on renal oxygenation and hemodynamics and prevention of kidney damage and inflammation in two in vivo AKI models. To induce AKI, male Wistar rats (n = 18) were subjected to renal ischemia (30 min) and reperfusion (I/R), or sham-operated. In a second model, rats (n = 18) received a 30 min infusion of lipopolysaccharide (LPS; 2.5 mg/kg), or saline, and fluid resuscitation. In both models, recAP (1000 U/kg) was administered intravenously (15 min before reperfusion, or 90 min after LPS). Following recAP treatment, I/R-induced changes in renal blood flow, renal vascular resistance and oxygen delivery at early, and cortical microvascular oxygen tension at late reperfusion were no longer significantly affected. RecAP did not influence I/R-induced effects on mean arterial pressure. During endotoxemia, recAP treatment did not modulate the LPS-induced changes in systemic hemodynamics and renal oxygenation. In both models, recAP did exert a clear renal protective anti-inflammatory effect, demonstrated by attenuated immunostaining of inflammatory, tubular injury and pro-apoptosis markers. Whether this renal protective effect is sufficient to improve outcome of patients suffering from sepsis-associated AKI is being investigated in a large clinical trial. - Highlights: • Human recombinant alkaline phosphatase (recAP) is a potential new therapy for sepsis-associated acute kidney injury (AKI). • RecAP can modulate renal oxygenation and hemodynamics immediately following I/R-induced AKI. • RecAP did not modulate endotoxemia-induced changes in systemic hemodynamics and renal oxygenation. • RecAP did exert a clear renal protective

  17. Endovascular treatment of renal artery stenoses

    International Nuclear Information System (INIS)

    Lashari, M.N.

    2015-01-01

    To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. Study Design: An experimental study. Place and Duration of Study: A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. Methodology: Hypertension (systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications) with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. Results: There were 25 patients, 14 (56%) male and 11 (44%) female, with mean age of 49 +- 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 (44%), 10 (40%) and 4 (16%) patients respectively. Renal insufficiency (serum creatinine > 1.5 mg/dl) was seen in one (04%) patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 (20%), 9 (36%) and 11(44%) patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 (80%) patients. A significant decrease in systolic (168.20 +- 9.987 vs. 140.60 +- 5.649 mmHg, p < 0.001) and diastolic blood pressure (88.60 +- 5.50 vs. 77.20 +- 5.017 mmHg, p < 0.001) and reduction of medication (2.72 +- 0.458 vs. 1.5 +- 0.510, p < 0.01) were noted without a change in renal function (p= 0.061) after renal artery stenting. Conclusion: Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment

  18. Renal hemodynamics in uranyl acetate-induced acute renal failure of rabbits

    International Nuclear Information System (INIS)

    Sudo, M.; Honda, N.; Hishida, A.; Nagase, M.

    1977-01-01

    The role of renal hemodynamic alterations in the curtailment of renal function was studied in rabbits with uranyl acetate-induced acute renal failure. The day following the i.v. injection of uranyl acetate (2 mg/kg of body wt), renal blood flow (RBF) and clearance of creatinine (Ccr) decreased to approximately 60 and 20% of controls, respectively. Intracortical fractional flow distribution, estimated by radioactive microsphere method, did not change. The extraction ratio of para-aminohippurate (EPAH) decreased and the renal extraction of sodium (CNa/Ccr) increased, with minimal structural change in the kidney. Urine output increased two to three times that of the control. After three days oliguria appeared despite complete recovery of RBF. The zonal flow redistributed toward the deep cortex. CCr and EPAH reached their minimums, concomitantly with tubular necrosis and intratubular casts. After seven days animals could be divided into the oliguric and diuretic groups. CCr and EPAH were higher in the diuretic group, while there was no significant difference in RBF and the flow distribution between groups. Regeneration of damaged tubular cells was found in the diuretic group but not in the oliguric group. The findings suggest the minor roles of RBF and the intracortical flow distribution, and a fundamental role of back leakage of filtrate across damaged tubular epithelium in the maintenance of reduced CCR and urine output during the oliguric stage in rabbits with uranyl acetate-induced renal failure

  19. Arrangement of Renal Arteries in Guinea Pig.

    Science.gov (United States)

    Mazensky, David; Flesarova, Slavka

    2017-03-01

    The aim of this study was to describe origin, localization, and variations of renal arteries in guinea pig. The study was carried out on 26 adult guinea pigs. We prepared corrosion casts of the guinea pig arterial system. Batson's corrosion casting kit no. 17 was used as the casting medium. In 57.7% of specimens, a. renalis dextra was present as a single vessel with different level of its origin from aorta abdominalis. In 38.5% of specimens, two aa. renales dextrae were present with variable origin and arrangement. The presence of three aa. renales dextrae we found in one specimen. In 76.9% of specimens, a. renalis sinistra was present as a single vessel with different level of its origin from aorta abdominalis and variable arrangement. In 23.1% of specimens, we found two aa. renales sinistrae with variable origin and arrangement. The anatomical knowledge of the renal arteries, and its variations are of extreme importance for the surgeon that approaches the retroperitoneal region in several experiments, results of which are extrapolated in human. This is the first work dealing with the description of renal arteries arrangement in guinea pig. Anat Rec, 300:556-559, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  20. Acute transplant renal artery thrombosis due to distal renal artery stenosis: A case report and review of the literature

    OpenAIRE

    Fallahzadeh, Mohammad Kazem; Yatavelli, Rajini Kanth; Kumar, Ajay; Singh, Neeraj

    2014-01-01

    Background: Acute renal artery thrombosis is a devastating complication of renal transplantation that can result in graft loss if not detected early. Surgical and technical errors are the major cause of renal artery thrombosis. In this article, for the first time, we are reporting a case of acute renal artery thrombosis that developed early post-transplantation due to distal renal artery stenosis. Case Presentation: A 71-year-old woman presented with nausea, vomiting and decreased urine outpu...

  1. Renal hemodynamic effects of activation of specific renal sympathetic nerve fiber groups.

    Science.gov (United States)

    DiBona, G F; Sawin, L L

    1999-02-01

    To examine the effect of activation of a unique population of renal sympathetic nerve fibers on renal blood flow (RBF) dynamics, anesthetized rats were instrumented with a renal sympathetic nerve activity (RSNA) recording electrode and an electromagnetic flow probe on the ipsilateral renal artery. Peripheral thermal receptor stimulation (external heat) was used to activate a unique population of renal sympathetic nerve fibers and to increase total RSNA. Total RSNA was reflexly increased to the same degree with somatic receptor stimulation (tail compression). Arterial pressure and heart rate were increased by both stimuli. Total RSNA was increased to the same degree by both stimuli but external heat produced a greater renal vasoconstrictor response than tail compression. Whereas both stimuli increased spectral density power of RSNA at both cardiac and respiratory frequencies, modulation of RBF variability by fluctuations of RSNA was small at these frequencies, with values for the normalized transfer gain being approximately 0.1 at >0.5 Hz. During tail compression coherent oscillations of RSNA and RBF were found at 0.3-0.4 Hz with normalized transfer gain of 0.33 +/- 0.02. During external heat coherent oscillations of RSNA and RBF were found at both 0.2 and 0.3-0.4 Hz with normalized transfer gains of 0. 63 +/- 0.05 at 0.2 Hz and 0.53 +/- 0.04 to 0.36 +/- 0.02 at 0.3-0.4 Hz. Renal denervation eliminated the oscillations in RBF at both 0.2 and 0.3-0.4 Hz. These findings indicate that despite similar increases in total RSNA, external heat results in a greater renal vasoconstrictor response than tail compression due to the activation of a unique population of renal sympathetic nerve fibers with different frequency-response characteristics of the renal vasculature.

  2. Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

    International Nuclear Information System (INIS)

    Dohan, Anthony; Eveno, Clarisse; Dautry, Raphael; Guerrache, Youcef; Camus, Marine; Boudiaf, Mourad; Gayat, Etienne; Dref, Olivier Le; Sirol, Marc; Soyer, Philippe

    2015-01-01

    PurposeTo assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).Materials and MethodsSeventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.ResultsSeventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).ConclusionTAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA

  3. Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Eveno, Clarisse, E-mail: clarisse.eveno@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dautry, Raphael, E-mail: raphael.dautry@lrb.aphp.fr; Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Camus, Marine, E-mail: marine.camus@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Boudiaf, Mourad, E-mail: mourad.boudiaf@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France); Gayat, Etienne, E-mail: etienne.gayat@lrb.aphp.fr [Université Paris-Diderot, Sorbonne Paris Cité (France); Dref, Olivier Le, E-mail: olivier.ledref@lrb.aphp.fr; Sirol, Marc, E-mail: marc.sirol@lrb.aphp.fr; Soyer, Philippe, E-mail: philippe.soyer@lrb.aphp.fr [Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Department of Abdominal and Interventional Imaging (France)

    2015-08-15

    PurposeTo assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).Materials and MethodsSeventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.ResultsSeventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).ConclusionTAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.

  4. Aneurisma da Artéria Renal: caso clínico Renal Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Joana Moreira

    2011-12-01

    Full Text Available Apresenta-se o caso clínico de um doente com volumoso aneurisma da artéria renal esquerda. Do sexo masculino, de 22 anos de idade, com lombalgia à esquerda com algumas semanas de evolução. Recorreu ao médico assistente que solicitou estudo imagiológico por ecografia abdominal. Detectada imagem sugestiva de aneurisma da aorta abdominal. Este achado motivou a transferência para o nosso Hospital onde foi admitido consciente e orientado, hemodinamicamente estável, apresentando uma massa pulsátil epigástrica, com frémito e sopro sistólico à auscultação. Angio-TC revelou um aneurisma da artéria renal esquerda com 16 cm de diâmetro. Dada a estabilidade clínica e topografia lesional optou-se por tentar embolizar, sem sucesso, o tronco da artéria renal esquerda antes da abordagem cirúrgica. O doente foi então submetido a Nefrectomia total esquerda por via toraco-abdominal. Pós-operatório sem complicações, locais ou sistémicas. Alta ao 8ºdia, mantendo boa função renal e com níveis normais de hemoglobina. Diagnóstico de aneurisma da artéria renal confirmado por estudo anátomo-patológico da peça operatória.One case of a large left renal artery aneurysm in a young patient 22 years old is presented. He appealed to his assistant physician a few weeks after development of left back pain. Abdominal ultrasound imaging study has been requested. Suggestive abdominal aortic aneurysm was detected. This finding led to the transfer to our hospital where he was admitted conscious and hemodynamically stable. A pulsatile epigastric mass with a systolic murmur on auscultation and thrill were detected. Angio-CT scan revealed a left renal artery aneurysm, 16 cm in diameter. Given the clinical stability and lesional topography we decide a previous embolization of left renal artery, unsuccessfully. The patient underwent then left total nephrectomy, through thoraco-abdominal incision. No local or systemic complications in the postoperative

  5. Endovascular management of renal transplant dysfunction secondary to hemodynamic effects related to ipsilateral femoral arteriovenous graft

    Science.gov (United States)

    Salsamendi, Jason; Pereira, Keith; Quintana, David; Bleicher, Drew; Tabbara, Marwan; Goldstein, Michael; Narayanan, Govindarajan

    2016-01-01

    Hemodialysis access options become complex in long-term treatment for patients with renal disease, while awaiting renal transplantation (RT). Once upper extremity sites are exhausted, lower extremities are used. RT is preferably in the contralateral iliac fossa, rarely ipsilateral. In current literature, RT dysfunction secondary to the hemodynamic effects of an ipsilateral femoral arteriovenous graft (AVG) has been rarely described. To our knowledge, AVG ligation is the only published technique for hemodynamic correction of an ipsilateral AVG. We present a simple, potentially reversible endovascular approach to manage the hemodynamic effects of an AVG, without potentially permanently losing future AVG access. PMID:26899147

  6. False iliac artery aneurysm following renal transplantation

    DEFF Research Database (Denmark)

    Levi, N; Sønksen, Jens Otto Reimers; Schroeder, T V

    1999-01-01

    We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously....... The graft never functioned and transplant nephrectomy was performed 2 weeks later. A CT-scanning showed a 10 x 10 cm large aneurysm arising from the left external iliac artery. At operation a large false aneurysm was identified arising from the original transplant anastomotic site. Due to the extent...

  7. Distal Embolic Protection for Renal Arterial Interventions

    International Nuclear Information System (INIS)

    Dubel, Gregory J.; Murphy, Timothy P.

    2008-01-01

    Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices

  8. The new technique of using the epigastric arteries in renal transplantation with multiple renal arteries

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Amirzargar

    2013-01-01

    Full Text Available The most common anatomic variant seen in the donor kidneys for renal transplantation is multiple renal arteries (MRA, which can cause an increased risk of complications. We describe the long-term outcomes of 16 years of experience in 76 kidney transplantations with MRAs. In a new reconstruction technique, we remove arterial clamps after anastomosing the donor to the recipient′s main renal vessels, which cause backflow from accessory arteries to prevent thrombosis. By this technique, we reduce the ischemic times as well as the operating times. Both in live or cadaver donor kidneys, lower polar arteries were anastomosed to the inferior epigastric artery and upper polar arteries were anastomosed to the superior epigastric arteries. Injection of Papaverine and ablation of sympathic nerves of these arteries dilate and prevent them from post-operative spasm. Follow-up DTPA renal scan in all patients showed good perfusion and function of the transplanted kidney, except two cases of polar arterial thrombosis. Mean creatinine levels during at least two years of follow-up remained acceptable. Patient and graft survival were excellent. No cases of ATN, hypertension, rejection and urologic complications were found. In conclusion, this technique can be safely and successfully utilized for renal transplantation with kidneys having MRAs, and may be associated with a lower complication rate and better graft function compared with the existing techniques.

  9. Management of Renal Artery Stenosis - an Update | Alhadad ...

    African Journals Online (AJOL)

    The role of the renal vasculature in eliciting renovascular hypertension (RVH) was established in 1934, when Goldblatt et al. [1] in a classical experimental study demonstrated that partial obstruction of the renal artery increased mean arterial blood pressure (BP). The pathophysiology of renal artery stenosis (RAS) is ...

  10. Renal artery stent angioplasty for renovascular hypertension

    International Nuclear Information System (INIS)

    Li Gang; Li Haiqing; Wang Lin

    2005-01-01

    Objective: To evaluate the therapeutic results of expandable stent for treatment of atherosclerotic renovascular obstructive disease. Methods: 15 patients (10 men and 5 women, 41-75 years old; mean age, 52 years) with renal arterial hypertension underwent renal stent angioplasty including renal arterial stenosis 89%(n=13) and fully obstruction without function in 2, of which 2 patients had bilateral involvement. The stenotic range of all arterial segments showed 60% to 90% width of the normal arterial diameter. 16 stents were implanted under the guidance of fluoroscopy. The most of stents implanted were Palmaz (n=12, 75%) with regular clinical and angiographic follow up. Results: Technical success (residual stenosis <30%) was achieved in all patients without serious complication. During the follow-up (6-15 months; mean, 8 ± 4 months), hypertension was improved in 9 patients and cured in 4 patients with a total benefit of 86% and no efficacy in 2(13%). The average systolic blood pressure decreased from 27.12 ± 3.09 kPa to 18.62 ± 3.12 kPa and the average diastolic blood pressure decreased from 17.73 ± 1.92 kPa to 11.12 ± 2.43 kPa after stent treatment (P<0.05). Serum creatinine remained stable in 60% (n=9) patients with improvement in 33% (n=5) and worsened in 6% (n=1) patients. Follow-up angiography was performed in all patients with 1 case of a restenosis. 6 months after expanding through stent by using balloon, the two follow up angiographies showed a stable restenosis about 20%. Conclusions: Percutaneous transluminal stent placement is highly beneficial for patients who had renal arterial obstructive disease. The success of stent angioplasty of complete obstructive renal arteries reveals wide prospects for interventional method. (authors)

  11. Arterial embolization therapy of traumatic renal hemorrhage

    International Nuclear Information System (INIS)

    Wu Changxu; Chen Xiaolin; Huang Changhai; Pu Ge

    2000-01-01

    Objective: To study the angiographic manifestations and arterial embolizatin for traumatic renal hemorrhage when conservative treatment had failed. methods: 5 cases, all male, ranging in age from 12-29 years. All cases had history of injury. the main symptoms included severe abdominal pain, hematuria or coffee colored urine, rapid heart rate, hypotension. 3 suffered hemorrhagic shock. All cases underwent angiographic exam and the diagnosis was confirmed. Embolization materials were mainly self-blood clot and gelfoam. Results: Symptoms in all cases subsided quickly after embolization. Blood pressure recovered to normal within 12 hours; Hematuresis and abdominal pain disappeared or reduced in 1-2 days. One month later, intravenous urographic exam revealed recovered function of the injured kidneys. Conclusion: Renal arterial embolization in treating traumatic renal hemorrhage can control the bleeding while preserving the injured kidneys

  12. Interventional treatment of arterial complications in post renal transplantation

    International Nuclear Information System (INIS)

    Qian Xiaojun; Dai Dingke; Zhai Renyou

    2004-01-01

    Objective: To report our experience of interventional procedure for arterial complications in post renal transplantation and to evaluate its clinical value. Methods: In a retrospective analysis of renal transplantations in our center, 52 cases of renal allograft artery abnormalities had taken angiography. Interventional procedure included transluminal angioplasty of arterial stenoses, treatment of arterial occlusion, and embolization of pseudoaneurysm. Results: Renal allograft artery abnormalities included artery stenosis (n=21), artery thrombosis (n=13) and embolision (n=1), renal artery pseudoaneurysms (n=2), and decrease of renal artery flow (n=3). Of the 21 artery stenosis, 2 grafts with artery stenosis were lost because the stenosis could not be corrected, and 3 with mild stenosis received no treatment. Another 16 accepted renal artery angioplasty (balloon dilation, n=12, and stent implantation, n=4). 14 achieved long-term allograft function. 1 graft was lost because renal function failed to recover. Restenosis occurred in one stent implantation, and lost the allograft function after secondary dilation. 13 cases received thrombolytic therapy through artery catheter for thrombosis and 9 achieved long-term allograft function. Thrombolyses failed in 3 cases, and renal function failed to recover in 1 case. One pseudoaneurysm received stent implantation after embolization, and got a short-term allograft function. The other one received allograft excision. Conclusion: Intravascular interventional therapy will be the first-line therapy for any indications of complication in post renal transplantation, and it can surely save the kidney in a majority of instances. (authors)

  13. Does Renal Artery Supply Indicate Treatment Success of Renal Denervation?

    Energy Technology Data Exchange (ETDEWEB)

    Schmid, Axel, E-mail: axel.schmid@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Radiology (Germany); Ditting, Tilmann, E-mail: tilmann.ditting@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany); Sobotka, Paul A., E-mail: sobotka@alumni.stanford.edu [Ohio State University (United States); Veelken, Roland, E-mail: roland.veelken@uk-erlangen.de; Schmieder, Roland E., E-mail: roland.schmieder@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany); Uder, Michael, E-mail: michael.uder@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Radiology (Germany); Ott, Christian, E-mail: christian.ott@uk-erlangen.de [University of Erlangen-Nuremberg, Department of Nephrology and Hypertension (Germany)

    2013-08-01

    PurposeRenal denervation (RDN) emerged as an innovative interventional antihypertensive therapy. With the exception of pretreatment blood pressure (BP) level, no other clear predictor for treatment efficacy is yet known. We analyzed whether the presence of multiple renal arteries has an impact on BP reduction after RDN.MethodsFifty-three patients with treatment-resistant hypertension (office BP {>=} 140/90 mmHg and 24-h ambulatory BP monitoring ({>=}130/80 mmHg) underwent bilateral catheter-based RDN. Patients were stratified into one-vessel (OV) (both sides) and at least multivessel (MV) supply at one side. Both groups were treated on one vessel at each side; in case of multiple arteries, only the dominant artery was treated on each side.ResultsBaseline clinical characteristics (including BP, age, and estimated glomerular filtration rate) did not differ between patients with OV (n = 32) and MV (n = 21). Office BP was significantly reduced in both groups at 3 months (systolic: OV -15 {+-} 23 vs. MV -16 {+-} 20 mmHg; diastolic: OV -10 {+-} 12 vs. MV -8 {+-} 11 mmHg, both p = NS) as well as 6 months (systolic: OV -18 {+-} 18 vs. MV -17 {+-} 22 mmHg; diastolic: OV -10 {+-} 10 vs. -10 {+-} 12 mmHg, both p = NS) after RDN. There was no difference in responder rate (rate of patients with office systolic BP reduction of at least 10 mmHg after 6 months) between the groups.ConclusionIn patients with multiple renal arteries, RDN of one renal artery-namely, the dominant one-is sufficient to induce BP reduction in treatment-resistant hypertension.

  14. Hemodynamics in stented vertebral artery ostial stenosis based on computational fluid dynamics simulations.

    Science.gov (United States)

    Qiao, Aike; Dai, Xuan; Niu, Jing; Jiao, Liqun

    2016-01-01

    Hemodynamic factors may affect the potential occurrence of in-stent restenosis (ISR) after intervention procedure of vertebral artery ostial stenosis (VAOS). The purpose of the present study is to investigate the influence of stent protrusion length in implantation strategy on the local hemodynamics of the VAOS. CTA images of a 58-year-old female patient with posterior circulation transient ischemic attack were used to perform a 3D reconstruction of the vertebral artery. Five models of the vertebral artery before and after the stent implantation were established. Model 1 was without stent implantation, Model 2-5 was with stent protruding into the subclavian artery for 0, 1, 2, 3 mm, respectively. Computational fluid dynamics simulations based on finite element analysis were employed to mimic the blood flow in arteries and to assess hemodynamic conditions, particularly the blood flow velocity and wall shear stress (WSS). The WSS and the blood flow velocity at the vertebral artery ostium were reduced by 85.33 and 35.36% respectively after stents implantation. The phenomenon of helical flow disappeared. Hemodynamics comparison showed that stent struts that protruded 1 mm into the subclavian artery induced the least decrease in blood speed and WSS. The results suggest that stent implantation can improve the hemodynamics of VAOS, while stent struts that had protruded 1 mm into the subclavian artery would result in less thrombogenesis and neointimal hyperplasia and most likely decrease the risk of ISR.

  15. Dietary melatonin alters uterine artery hemodynamics in pregnant Holstein heifers.

    Science.gov (United States)

    Brockus, K E; Hart, C G; Gilfeather, C L; Fleming, B O; Lemley, C O

    2016-04-01

    The objective was to examine uterine artery hemodynamics and maternal serum profiles in pregnant heifers supplemented with dietary melatonin (MEL) or no supplementation (CON). In addition, melatonin receptor-mediated responses in steroid metabolism were examined using a bovine endometrial epithelial culture system. Twenty singleton pregnant Holstein heifers were supplemented with 20 mg of melatonin (n = 10) or no melatonin supplementation (control; n = 10) from days 190 to 262 of gestation. Maternal measurements were recorded on days 180 (baseline), 210, 240, and 262 of gestation. Total uterine blood flow was increased by 25% in the MEL-treated heifers compared with the CON. Concentrations of progesterone were decreased in MEL vs CON heifers. Total serum antioxidant capacity was increased by 43% in MEL-treated heifers when compared with CON. Activity of cytochrome P450 1A, 2C, and superoxide dismutase was increased in bovine endometrial epithelial cells treated with melatonin, whereas the melatonin receptor antagonist, luzindole, negated the increase in cytochrome P450 2C activity. Moreover, estradiol or progesterone treatment altered bovine uterine melatonin receptor expression, which could potentiate the melatonin-mediated responses during late gestation. The observed increase in total uterine blood flow during melatonin supplementation could be related to its antioxidant properties. Compromised pregnancies are typically accompanied by increased oxidative stress; therefore, melatonin could serve as a therapeutic supplementation strategy. This could lead to further fetal programming implications in conjunction with offspring growth and development postnatally. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Treatment of acute renal artery embolism

    International Nuclear Information System (INIS)

    Fava, C.; Grosso, M.; Malara, D.; Barile, C.

    1987-01-01

    The possible ways of treating renal artery embolisms are reviewed with an examination of their advantages and defects. Surgical treatment has a fairly high mortality rate but quickly cures any type of vascular occlusion and will cures any type of vascular occlusion and will cure any concomitant problems such as arterial stenosis. Medical treatement with anticoagulant or mortality rate and is effective even on narrow blood vessels but the response varies according to the type of thromboembolic damage and the way the drugs are administred. Recently developed forms of radiological treatment are also examined. A personal technique successfully applied to an embolism in a patient with only one functioning kidney is described. It consists of a two-stepmechanical and pharmacological attack. First the occluded artery was opened by means of a balloon catheter that was pushedbeyond the embolism and withdrawn into the aorta after inflation of the balloon. Thrombolytic drugs (Urokinase) were then infused through the catheter into the bed of the renal artery in order to cure the secondary thrombosis found, as is generally the case, downstream of the embolism. The technique appears ideal for the treatment of patients with embolisms and total involvement of the renal parenchyma, especially when their general condition makes surgery inadvisable

  17. Does Renal Artery Supply Indicate Treatment Success of Renal Denervation?

    International Nuclear Information System (INIS)

    Schmid, Axel; Ditting, Tilmann; Sobotka, Paul A.; Veelken, Roland; Schmieder, Roland E.; Uder, Michael; Ott, Christian

    2013-01-01

    PurposeRenal denervation (RDN) emerged as an innovative interventional antihypertensive therapy. With the exception of pretreatment blood pressure (BP) level, no other clear predictor for treatment efficacy is yet known. We analyzed whether the presence of multiple renal arteries has an impact on BP reduction after RDN.MethodsFifty-three patients with treatment-resistant hypertension (office BP ≥ 140/90 mmHg and 24-h ambulatory BP monitoring (≥130/80 mmHg) underwent bilateral catheter-based RDN. Patients were stratified into one-vessel (OV) (both sides) and at least multivessel (MV) supply at one side. Both groups were treated on one vessel at each side; in case of multiple arteries, only the dominant artery was treated on each side.ResultsBaseline clinical characteristics (including BP, age, and estimated glomerular filtration rate) did not differ between patients with OV (n = 32) and MV (n = 21). Office BP was significantly reduced in both groups at 3 months (systolic: OV −15 ± 23 vs. MV −16 ± 20 mmHg; diastolic: OV −10 ± 12 vs. MV −8 ± 11 mmHg, both p = NS) as well as 6 months (systolic: OV −18 ± 18 vs. MV −17 ± 22 mmHg; diastolic: OV −10 ± 10 vs. −10 ± 12 mmHg, both p = NS) after RDN. There was no difference in responder rate (rate of patients with office systolic BP reduction of at least 10 mmHg after 6 months) between the groups.ConclusionIn patients with multiple renal arteries, RDN of one renal artery—namely, the dominant one—is sufficient to induce BP reduction in treatment-resistant hypertension

  18. The renal arterial resistive index and stage of chronic kidney disease in patients with renal allograft

    DEFF Research Database (Denmark)

    Winther, Stine O; Thiesson, Helle C; Poulsen, Lene N

    2012-01-01

    The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft.......The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft....

  19. “Transcollateral” Renal Angioplasty for a Completely Occluded Renal Artery

    International Nuclear Information System (INIS)

    Chandra, Subash; Chadha, Davinder S.; Swamy, Ajay

    2011-01-01

    Percutaneous transluminal renal angioplasty with stenting has been effective in the control of hypertension, renal function, and pulmonary edema caused by atherosclerotic renal artery stenosis. However, the role of the procedure has not been fully established in the context of chronic total occlusion of renal artery. We report the successful use of this procedure in 57-year-old male patient who reported for evaluation of a recent episode of accelerated hypertension. A renal angiogram in this patient showed ostial stenosis of the right renal artery, which was filling by way of the collateral artery. Renal angioplasty for chronic total occlusion of right renal artery was successfully performed in a retrograde fashion through a collateral artery, thereby leading to improvement of renal function and blood pressure control.

  20. MR angiography of in situ and transplanted renal arteries

    International Nuclear Information System (INIS)

    Smith, H.J.; Bakke, S.J.

    1993-01-01

    Three-dimensional (3D) time-of-flight (TOF) MR angiography (MRA) was performed in 34 patients with suspected renal artery disease. In situ (i.e., nontransplanted) renal arteries were studied with MRA in 14 patients. Of these, 12 had conventional angiography for comparison. Twenty-four MRAs of transplanted renal arteries were obtained in 20 patients; 8 of these had angiography as well. Significant stenoses of in situ renal arteries were diagnosed with a sensitivity of 100% and a specificity of 95%. The stenoses were all proximal; 3D TOF MRA proved inadequate for depiction of peripheral renal arteries. MRA and angiography showed good agreement between findings in 7 of 8 patients with renal transplants. In one patient with a renal transplant, MRA showed a significant stenosis of the arterial anastomosis which appeared completely normal at i.a. DSA, indicating that findings at MRA still need to be confirmed by more established alternative methods. (orig.)

  1. [Embolization of a renal artery aneurysm. Effect of an ESWL?].

    Science.gov (United States)

    Bovenschulte, H

    2010-05-01

    The development of a peripheral aneurysm of the renal artery as a result of an ESWL is a rarely described complication. We discuss in the presented case the diagnosis and successful endovascular treatment of a complicated aneurysm of a renal segment artery with complete preservation of the renal parenchyma.

  2. High success rate after arterial renal embolisation

    DEFF Research Database (Denmark)

    Thorlund, Mie Gaedt; Egge Wennevik, Gjertrud; Andersen, Margrethe

    2015-01-01

    . RESULTS: In total, 35 patients were included; their mean age was 64 years (range: 17-95 years): eight females and 27 males. A total of 15 patients underwent embolisation due to renal cancer; nine elective and six acute procedures. Seven traumas were embolised. Five AML patients underwent embolisation......INTRODUCTION: The objective of this study was to present patients who underwent either elective or acute renal embolisation in a single centre where embolisation was available at all hours. METHODS: The records of all patients who underwent transcatheter arterial embolisation (TAE) at Odense...... University Hospital from October 2010 to July 2013 were extracted retrospectively and examined to determine the indication for treatment, procedural details and complications. Patients were divided into four groups: renal cancer, trauma, angiomyolipoma (AML) and others. When there was indication...

  3. Role of vascular potassium channels in the regulation of renal hemodynamics

    DEFF Research Database (Denmark)

    Sørensen, Charlotte Mehlin; Braunstein, Thomas Hartig; von Holstein-Rathlou, Niels-Henrik

    2012-01-01

    of one or more classes of K+ channels will lead to a change in hemodynamic resistance and therefore of renal blood flow and glomerular filtration pressure. Through these effects, the activity of renal vascular K+ channels influences renal salt and water excretion, fluid homeostasis, and ultimately blood...... pressure. Four main classes of K+ channels [calcium activated (KCa), inward rectifier (Kir), voltage activated (KV), and ATP sensitive (KATP)] are found in the renal vasculature. Several in vitro experiments have suggested a role for individual classes of K+ channels in the regulation of renal vascular...... function. Results from in vivo experiments are sparse. We discuss the role of the different classes of renal vascular K+ channels and their possible role in the integrated function of the renal microvasculature. Since several pathological conditions, among them hypertension, are associated with alterations...

  4. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

    International Nuclear Information System (INIS)

    Gupta, Nakul; Patel, Anish; Ensor, Joe; Ahrar, Kamran; Ahrar, Judy; Tam, Alda; Odisio, Bruno; Huang, Stephen; Murthy, Ravi; Mahvash, Armeen; Avritscher, Rony; McRae, Stephen; Sabir, Sharjeel; Wallace, Michael; Matin, Surena; Gupta, Sanjay

    2017-01-01

    PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

  5. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Nakul [Houston Methodist Hospital (United States); Patel, Anish [The University of Texas Southwestern Medical Center (United States); Ensor, Joe [Houston Methodist Research Institute, The Houston Methodist Cancer Center (United States); Ahrar, Kamran; Ahrar, Judy; Tam, Alda; Odisio, Bruno; Huang, Stephen; Murthy, Ravi; Mahvash, Armeen; Avritscher, Rony; McRae, Stephen; Sabir, Sharjeel; Wallace, Michael [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States); Matin, Surena [The University of Texas MD Anderson Cancer Center, Department of Urology (United States); Gupta, Sanjay, E-mail: sgupta@mdanderson.org [The University of Texas MD Anderson Cancer Center, Department of Interventional Radiology (United States)

    2017-02-15

    PurposeTo describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores.Materials and MethodsThe medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization.ResultsTwenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR.ConclusionA majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.

  6. INSTRUMENTAL AND DIAGNOSTIC CRITERIA OF HEMODYNAMIC DISORDERS AND ENDOTHELIAL DYSFUNCTION CORRECTION IN PREGNANTS WITH ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    S. M. Heryak

    2014-12-01

    Conclusions. It was found that the brachial artery ultrasound measuring and occlusive plethysmography procedure by Dietz is an early and safe method of endothelial dysfunction diagnostic in pregnants with hypertension. Doppler ultrasound of blood flow in uterine, umbilical arteries, and middle cerebral arteries of the fetus allows timely diagnosis of the side effect of antihypertensive drugs on the fetus. The therapy of choice for pregnants with Stage II Arterial Hypertension should be based on methyldopa and calcium channel antagonists or selective beta-blockers combination. Highly selective beta-blockers with vasodilative effect (nebivolol hydrochloride and L-arginine (Tivortin allow to prevent perinatal adverse effects of antihypertensive therapy, to correct hemodynamic disorders and endothelial dysfunction in pregnants with arterial hypertension. KEY WORDS: arterial hypertension, uterine-placental hemodynamics, endothelial dysfunction

  7. Alpha-adducin Gly460Trp polymorphism and renal hemodynamics in essential hypertension

    NARCIS (Netherlands)

    Beeks, Esther; van der Klauw, Melanie M; Kroon, Abraham A; Spiering, Wilko; Fuss-Lejeune, Monique J M J; de Leeuw, Peter W

    2004-01-01

    Previous studies have shown an association between the alpha-adducin Gly460Trp polymorphism and salt-sensitive hypertension. Not much is known about the effects of the variants of this polymorphism on renal hemodynamics and function. Therefore, we performed the present study to investigate the

  8. Venous digital subtraction angiography for diagnosis of renal artery stenosis in arterial hypertony

    International Nuclear Information System (INIS)

    Schoerner, W.; Kempter, H.; Banzer, D.; Aviles, C.; Weiss, T.; Felix, R.

    1984-01-01

    Venous digital subtraction angiography was performed in 248 patients for the diagnosis of renal arterial stenosis. In 88% of the investigations the stenosis could be found. Comparison of digital angiography and conventional angiography was made for 57 renal arteries (25 investigations). In 52 renal arteries we found the same results with both methods, in 5 renal arteries we found the same results with both methods, in 5 renal arteries the digital angiography showed false positive results. The spatial resolution of digital subtraction angiography is sufficient for the correct diagnosis of significant renal arterial stenosis. With regard to the lower invasion of digital subtraction angiography compared to conventional angiography the first method should be used for clarification of renal arterial hypertension. (orig.)

  9. Anatomic Patterns of Renal Arterial Sympathetic Innervation: New Aspects for Renal Denervation.

    Science.gov (United States)

    Imnadze, Guram; Balzer, Stefan; Meyer, Baerbel; Neumann, Joerg; Krech, Rainer Horst; Thale, Joachim; Franz, Norbert; Warnecke, Henning; Awad, Khaled; Hayek, Salim S; Devireddy, Chandan

    2016-12-01

    Initial studies of catheter-based renal arterial sympathetic denervation to lower blood pressure in resistant hypertensive patients renewed interest in the sympathetic nervous system's role in the pathogenesis of hypertension. However, the SYMPLICITY HTN-3 study failed to meet its prespecified blood pressure lowering efficacy endpoint. To date, only a limited number of studies have described the microanatomy of renal nerves, of which, only two involve humans. Renal arteries were harvested from 15 cadavers from the Klinikum Osnabruck and Schuchtermann Klinik, Bad Rothenfelde. Each artery was divided longitudinally in equal thirds (proximal, middle, and distal), with each section then divided into equal superior, inferior, anterior, and posterior quadrants, which were then stained. Segments containing no renal nerves were given a score value = 0, 1-2 nerves with diameter 4 nerves or nerve diameter ≥600 µm a score = 3. A total of 22 renal arteries (9 right-sided, 13 left-sided) were suitable for examination. Overall, 691 sections of 5 mm thickness were prepared. Right renal arteries had significantly higher mean innervation grade (1.56 ± 0.85) compared to left renal arteries (1.09 ± 0.87) (P renal artery has significantly higher innervation scores than the left. The anterior and superior quadrants of the renal arteries scored higher in innervation than the posterior and inferior quadrants did. The distal third of the renal arteries are more innervated than the more proximal segments. These findings warrant further evaluation of the spatial innervation patterns of the renal artery in order to understand how it may enhance catheter-based renal arterial denervation procedural strategy and outcomes. The SYMPLICITY HTN-3 study dealt a blow to the idea of the catheter-based renal arterial sympathetic denervation. We investigated the location and patterns of periarterial renal nerves in cadaveric human renal arteries. To quantify the density of the

  10. How to manage hypertension with atherosclerotic renal artery stenosis?

    Science.gov (United States)

    Ricco, Jean-Baptiste; Belmonte, Romain; Illuminati, Guilio; Barral, Xavier; Schneider, Fabrice; Chavent, Bertrand

    2017-04-01

    The management of atherosclerotic renal artery stenosis (ARAS) in patients with hypertension has been the topic of great controversy. Major contemporary clinical trials such as the Cardiovascular Outcomes for Renal Artery lesions (CORAL) and Angioplasty and Stenting for Renal Atherosclerotic lesions (ASTRAL) have failed to show significant benefit of revascularization over medical management in controlling blood pressure and preserving renal function. We present here the implications and limitations of these trials and formulate recommendations for management of ARAS.

  11. Renal artery entrapment by the diaphragmatic crus

    International Nuclear Information System (INIS)

    Thony, F.; Baguet, J.-P.; Rodiere, M.; Sessa, C.; Janbon, B; Ferretti, G.

    2005-01-01

    The aim of this study is to describe renal artery entrapment (RAE) by the diaphragmatic crus and to elucidate the diagnostic and therapeutic approach to this entity. From 1995 to 2002, 15 patients (mean age 65) were found to have a RAE. They were investigated by CT scan (n=14) and/or MRA (n=2) for hypertension (n=7), chronic renal insufficiency (n=4) or aneurysms (n=4). The right (n=11) or the left (n=4) renal artery (RA) was involved. The compression was ostial (n=8) or truncal (n=7), and was ≥50% in eight cases. The course of the RA along the aorta on angiographic views (n=8) or a concentric ostial stenosis in a patient free of atheromatous lesions (n=7) were two findings suggestive of an RAE. Seven RAEs were indicated for treatment but only three were treated, by mean of stenting. Among the latter, two stents were patent at 6-month follow-up and one evolved to restenosis because of a stent fracture. RAEs may be suspected on angiographic views and proved by cross-sectional imaging because of specific imaging features. It is of importance to detect this etiology of RA stenosis because angioplasty with stenting is probably not always advisable. (orig.)

  12. Cerebral hematocrit decreases with hemodynamic compromise in carotid artery occlusion: a PET study.

    Science.gov (United States)

    Yamauchi, H; Fukuyama, H; Nagahama, Y; Katsumi, Y; Okazawa, H

    1998-01-01

    This study investigated whether in patients with internal carotid artery occlusion the regional cerebral hematocrit correlates with cerebral hemodynamics or metabolic state and, if so, how the regional cerebral hematocrit changes in the hemodynamically compromised region. We used positron emission tomography to study seven patients with unilateral internal carotid artery occlusion and no cortical infarction in the chronic stage. The distributions of red blood cell and plasma volumes were assessed using oxygen-15-labeled carbon monoxide and copper-62-labeled human serum albumin-dithiosemicarbazone tracers, respectively. The calculated hematocrit value was compared with the hemodynamic and metabolic parameters measured with the oxygen-15 steady-state technique. In the cerebral cortex, the value of the cerebral hematocrit varied but was correlated with the hemodynamic and metabolic status. Stepwise regression analysis revealed that the large vessel hematocrit, the cerebral metabolic rate of oxygen, and the cerebral blood flow or the oxygen extraction fraction accounted for a significant proportion of variance of the cerebral hematocrit. The oxygen extraction fraction and the cerebral metabolic rate of oxygen negatively correlated with the cerebral hematocrit, whereas the cerebral blood flow correlated positively: patients with reduced blood supply relative to metabolic demand (decreased blood flow with increased oxygen extraction fraction) showed low hematocrit values. In carotid artery occlusion in the chronic stage, regional cerebral hematocrit may vary according to cerebral hemodynamics and metabolic status. Regional cerebral hematocrit may decrease with hemodynamic compromise unless oxygen metabolism concomitantly decreases.

  13. Impaired renal allograft function is associated with increased arterial stiffness in renal transplant recipients

    DEFF Research Database (Denmark)

    Kneifel, M; Scholze, A; Burkert, A

    2006-01-01

    It is important whether impairment of renal allograft function may deteriorate arterial stiffness in renal transplant recipients. In a cross-sectional study, arterial vascular characteristics were non-invasively determined in 48 patients with renal allograft using applanation tonometry and digital...

  14. Does the presence of accessory renal arteries affect the efficacy of renal denervation?

    Science.gov (United States)

    Id, Dani; Kaltenbach, Benjamin; Bertog, Stefan C; Hornung, Marius; Hofmann, Ilona; Vaskelyte, Laura; Sievert, Horst

    2013-10-01

    This study sought to assess the efficacy of catheter-based renal sympathetic denervation in patients with accessory renal arteries and to compare the blood pressure (BP)-lowering effect with that observed in patients with bilateral single renal arteries after renal denervation. Catheter-based renal sympathetic denervation causes significant BP reductions in patients with resistant hypertension. Seventy-four patients were included in this study. Patients were assigned to 2 main groups: a bilateral single renal arteries group I (n = 54) and an accessory renal arteries group II (n = 20). Group II consisted of 9 patients whose accessory renal arteries were all denervated (group IIa), and 11 patients whose accessory renal arteries were not, or only incompletely, denervated (group IIb). The primary endpoint was the change in office systolic BP after 6 months. The procedure was successful in all patients. Group I: mean BP at baseline was 166.2/89.4 ± 20.5/14.6 mm Hg and decreased by -16.6 (p renal denervation in patients with accessory renal arteries is less pronounced than in patients with bilateral single renal arteries. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Impact of Intra-Extracranial Hemodynamics on Cerebral Ischemia by Arterial Hypertension (Part 2

    Directory of Open Access Journals (Sweden)

    Alexander G. Kruglov, PhD, ScD

    2012-06-01

    Full Text Available The association between hemodynamic and biochemical parameters of cerebral blood flow have been studied in man, using mathematical methods of statistics. The values have been obtained through catheterization using a probe jammed at the level of the bulb of the superior jugular vein. Relationships with central hemodynamic parameters have been evaluated, including the right atrium, the right ventricle, and the left ventricle, as well as with pressure and biochemical values of the arterial bed. Data have been acquired in patients with stable arterial hypertension. Analysis of all relationship between hemodynamic and biochemical parameters has shown that the uniform hemodynamic zone: Sin.P. – SJV – SEV – the right atrium, normally participates in regulation of gaseous exchange in the human brain depending on the minimum pressure on the way of outflow from the brain. In stable arterial hypertension, this type of regulation is lost. On the basis of the results of this study, it has been concluded that blood viscosity is normally a primary controlled parameter of homeostasis. In stable arterial hypertension, homeostatic control of factors determining rheological and thrombogenic properties of blood, as well as participating in the development of brain ischemic conditions is lost. This increases risk of disturbances in central hemodynamics.

  16. Frequency of renal artery stenosis in patients undergoing cardiac catheterization

    International Nuclear Information System (INIS)

    Lashari, M.N.; Ahmed, R.; Soomro, K.; Ishaq, M.

    2009-01-01

    Due to scarcity of local data regarding frequency of Renal Artery Stenosis (RAS), it is important to perform simultaneous renal arteriography in Patients undergoing coronary arterteriography for suspected coronary artery disease (CAD), in order to recognize all potential candidates for renal artery stenosis. It is cross sectional study. Three hundred patients, 157 male and 143 female with average age of 56+-8 Years and 55+-7 years respectively underwent simultaneous coronary and renal arteriography. Renal artery stenosis (RAS) was identified in 23.6% patients. Significant RAS (>50%) was present in 15% of patients. Hypertension, Dyslipidemia, smoking and diabetes mellitus were present in 88%, 80%, 50% and 49% respectively. Three vessel, two vessel and single vessel disease were seen in 58 %, 36% and 6% of patients. It is important to do simultaneous coronary and renal arteriography especially in patient having multiple risk factors and multi vessel coronary artery disease. (author)

  17. Frequency of renal artery stenosis in patients undergoing cardiac catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Lashari, M N; Ahmed, R; Soomro, K; Ishaq, M [Civil Hospital, Karachi (Pakistan)

    2009-07-15

    Due to scarcity of local data regarding frequency of Renal Artery Stenosis (RAS), it is important to perform simultaneous renal arteriography in Patients undergoing coronary arterteriography for suspected coronary artery disease (CAD), in order to recognize all potential candidates for renal artery stenosis. It is cross sectional study. Three hundred patients, 157 male and 143 female with average age of 56+-8 Years and 55+-7 years respectively underwent simultaneous coronary and renal arteriography. Renal artery stenosis (RAS) was identified in 23.6% patients. Significant RAS (>50%) was present in 15% of patients. Hypertension, Dyslipidemia, smoking and diabetes mellitus were present in 88%, 80%, 50% and 49% respectively. Three vessel, two vessel and single vessel disease were seen in 58 %, 36% and 6% of patients. It is important to do simultaneous coronary and renal arteriography especially in patient having multiple risk factors and multi vessel coronary artery disease. (author)

  18. Renal artery stenosis: comparative assessment by unenhanced renal artery mra versus contrast-enhanced MRA

    International Nuclear Information System (INIS)

    Khoo, Michael M.Y.; Deeab, Dhafer; Gedroyc, Wladyslaw M.W.; Dick, Elizabeth A.; Duncan, Neil; Taube, David

    2011-01-01

    To evaluate steady-state free precession (SSFP) non-contrast-enhanced MR angiography (Unenhanced-MRA) versus conventional contrast-enhanced MR angiography (CE-MRA) in the detection of renal artery stenosis (RAS). Retrospective analysis of 70 consecutive patients referred for suspected RAS, examined by SSFP Unenhanced-MRA and CE-MRA. Image quality, quality of visible renal arterial segments, presence and grade of RAS were evaluated. The Unenhanced-MRA were compared against reference standard CE-MRA results. 149 renal arteries were assessed with 21 haemodynamically significant stenoses (≥50% stenosis) demonstrated by CE-MRA. Combined sensitivity and specificity for RAS detection by Unenhanced-MRA was 72.8% and 97.8% respectively. There is substantial correlation for RAS detection between Unenhanced-MRA and CE-MRA with kappa values of between 0.64 and 0.74. There was excellent inter-observer correlation for RAS on Unenhanced-MRA (kappa values 0.82-1.0). Our study has shown Unenhanced-MRA to be a viable alternative to CE-MRA, yielding images equal in quality without the requirement for gadolinium contrast agents. The sensitivity and specificity for the detection of haemodynamically significant stenoses are comparable to CE-MRA. Potentially, Unenhanced-MRA could be used as an initial investigation to avoid performing CE-MRA in patients with normal renal arteries, however we suggest that its real value will lie in being complementary to CE-MRA. (orig.)

  19. MR angiography and the preoperative evaluation of renal arteries

    International Nuclear Information System (INIS)

    Nakahara, Kimitoshi; Yokoyama, Hiroshi; Tsuji, Yuji

    2001-01-01

    To determine the accuracy of gadolinium-enhanced, three-dimensional, magnetic resonance angiography (3D-MRA) in the visualization of the arterial anatomy of the kidney, we compared preoperative 3D-MRA results with surgical findings in 37 patients who underwent renal surgery. 3D-MRA findings were confirmed surgically in 30 of these patients (81%). However, 4 of 7 accessory renal arteries were missed by this imaging technique. Furthermore, 3D-MRA failed to visualize renal arteries in all of the three atrophic kidneys. 3D-MRA is a safe and reliable procedure for the preoperative evaluation of renal arteries. However, the depiction of smaller renal arteries, such as accessory and atrophic arteries, is less accurate. (author)

  20. MR angiography and the preoperative evaluation of renal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Nakahara, Kimitoshi; Yokoyama, Hiroshi; Tsuji, Yuji [Fukuoka Univ. (Japan). School of Medicine

    2001-04-01

    To determine the accuracy of gadolinium-enhanced, three-dimensional, magnetic resonance angiography (3D-MRA) in the visualization of the arterial anatomy of the kidney, we compared preoperative 3D-MRA results with surgical findings in 37 patients who underwent renal surgery. 3D-MRA findings were confirmed surgically in 30 of these patients (81%). However, 4 of 7 accessory renal arteries were missed by this imaging technique. Furthermore, 3D-MRA failed to visualize renal arteries in all of the three atrophic kidneys. 3D-MRA is a safe and reliable procedure for the preoperative evaluation of renal arteries. However, the depiction of smaller renal arteries, such as accessory and atrophic arteries, is less accurate. (author)

  1. Early post transplantation renal allograft perfusion failure due to intimal dissection of the renal artery

    Directory of Open Access Journals (Sweden)

    Khattab Omar

    2009-01-01

    Full Text Available Transplant renal artery stenosis (TRAS is a recognized and potentially curable cause of post transplant arterial hypertension, allograft dysfunction, and graft loss. It usually occurs 3 months to 2 years after transplantation, but early or later presentations are not uncommon. We present a case of renal artery narrowing due to intimal dissection that was managed medically.

  2. Multiple vascular anomalies involving renal, testicular and suprarenal arteries

    Directory of Open Access Journals (Sweden)

    Suresh Rao

    2015-09-01

    Full Text Available Knowledge of variations of blood vessels of the abdomen is important during operative, diagnostic and endovascular pro- cedures. During routine dissection of the abdominal cavity, we came across multiple vascular anomalies involving renal, suprarenal and testicular arteries. The left kidney was supplied by two renal arteries originating together from the abdomi- nal aorta, and the right kidney was supplied by two accessory renal arteries, one of which was arising from the right renal artery and the other one from the aorta (about 2 inches below the origin of the renal artery. Accessory renal veins were present on both sides. The right testicular artery was arising from the lower accessory renal artery. The left testicular artery was looping around the inferior tributary of the left renal vein, whereby forming a sharp kink. The left middle suprarenal artery was diving into three small branches; the upper two branches were supplying the left suprarenal gland, whereas the lower branch was supplying the left kidney. Furthermore, detailed literature and the clinical and surgical importance of the case are discussed. [Arch Clin Exp Surg 2015; 4(3.000: 168-171

  3. Renal artery anatomy affects the blood pressure response to renal denervation in patients with resistant hypertension.

    Science.gov (United States)

    Hering, Dagmara; Marusic, Petra; Walton, Antony S; Duval, Jacqueline; Lee, Rebecca; Sata, Yusuke; Krum, Henry; Lambert, Elisabeth; Peter, Karlheinz; Head, Geoff; Lambert, Gavin; Esler, Murray D; Schlaich, Markus P

    2016-01-01

    Renal denervation (RDN) has been shown to reduce blood pressure (BP), muscle sympathetic nerve activity (MSNA) and target organ damage in patients with resistant hypertension (RH) and bilateral single renal arteries. The safety and efficacy of RDN in patients with multiple renal arteries remains unclear. We measured office and 24-hour BP at baseline, 3 and 6 months following RDN in 91 patients with RH, including 65 patients with single renal arteries bilaterally (group 1), 16 patients with dual renal arteries on either one or both sides (group 2) and 10 patients with other anatomical constellations or structural abnormalities (group 3). Thirty nine out of 91 patients completed MSNA at baseline and follow-up. RDN significantly reduced office and daytime SBP in group 1 at both 3 and 6 months follow-up (Pkidney function in any group. While RDN can be performed safely irrespective of the underlying renal anatomy, the presence of single renal arteries with or without structural abnormalities is associated with a more pronounced BP and MSNA lowering effect than the presence of dual renal arteries in patients with RH. However, when patients with dual renal arteries received renal nerve ablation in all arteries there was trend towards a greater BP reduction. Insufficient renal sympathetic nerve ablation may account for these differences. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. An experimental study on renal arterial and parenchymal change caused by selective renal infusion of epinephrine

    International Nuclear Information System (INIS)

    Jeon, Seok Chol; Yeon, Kyung Mo; Han, Man Chung

    1981-01-01

    Selective infusion of the epinephrine into the renal artery has been used in the field of the diagnostic and the therapeutic radiology for correct diagnosis and effective treatment, respectively. However, administration of overdose of epinephrine may cause serious complication, renal infarction. The study was undertaken to evaluate the sequential change of renal arterial constrictive effect of selective infusion of epinephrine into renal artery and to determine the critical doses of epinephrine producing irreversible renal infarct. A total of 25 rabbits are used, which are divided into 5 groups. Under the general anesthesia is made the selective infusion of various doses of epinephrine into the right renal artery of the rabbits. At the various time interval during and after the epinephrine infusion, renal angiography was done, and 24 hrs. later, gross and microscopic findings of the kidney were observed. The results are as follows; 1. Vasoconstriction of renal artery occurred within 2 mins. infusion, and maximum effect within 5 mins. 2. It seems that there is correlation between the amount of infused epinephrine and the time taken to recover from constriction of renal artery. 3. When epinephrine is infused into the renal artery in the rate of 1 ug/min., renal infarct is not noticed below the level of 10 mins., but correlation between the amount of infused epinephrine and the frequency of renal infarct occurs above 20 mins. infusion

  5. Renal hemodynamic and neurohumoral responses to urapidil in hypertensive man

    International Nuclear Information System (INIS)

    de Leeuw, P.W.; van Es, P.N.; de Bruyn, H.A.; Birkenhaeger, W.H.D.

    1988-01-01

    In order to evaluate the acute effects of urapidil on renal vascular tone and on pressor systems we performed a randomized placebo-controlled crossover study in 8 patients with uncomplicated essential hypertension. Each subject received, on two separate days one week apart, an intravenous injection of either placebo or urapidil (25 mg, to be increased to 50 mg if blood pressure did not fall within 5 minutes). Before and following this injection we measured blood pressure and heart rate (Dinamap), renal plasma flow ( 125 I-hippuran), renin, angiotensin II, aldosterone, and catecholamines. The results show that urapidil, when compared to placebo, significantly reduced blood pressure, while increasing heart rate, renal blood flow, noradrenaline and adrenaline. Dopamine levels, on the other hand, were suppressed. While renin and angiotensin II were only mildly stimulated, aldosterone levels increased markedly. It is concluded that urapidil, given intravenously, has an immediate blood pressure lowering effect associated with a fall in renal vascular tone and an increase in renal perfusion. As a consequence both the sympathetic system and the renin-angiotensin system are stimulated, although the latter only to a mild degree. The rise in aldosterone may be related to withdrawal of dopaminergic tone

  6. [Anatomy character of renal artery and treatment of living-donor renal transplantation].

    Science.gov (United States)

    Zhang, Lei; Fei, Ji-guang; Chen, Li-zhong; Wang, Chang-xi; Deng, Su-xiong; Qiu, Jiang; Li, Jun; Chen, Guo-dong; Huang, Gang

    2009-12-15

    To study the anatomy characters of renal artery and the treatment of multiple arteries in living donor renal grafts. Records of 142 living donors were analyzed in our center. We analyzed the anatomic structure of renal arteries by DSA and CTA pre-transplantation. Thirty-one kidneys with multiple arteries were transplanted after reconstruction. Then clinical effects were compared between multiple-renal-arteries group (n=31) and single-renal-artery group (n=111). The incidence of multiple renal artery was 30.99%, and there was no difference between both sides (left kidney 22.54%, right kidney 22.13%). If the multiple artery occurred in left or right kidney, the incidence of the multiple artery occurred in the other side was 56.25% and 60.00%, respectively. The diameter of left main renal artery was more magnanimous (P=0.001) and the first branch was more closed to abdominal aorta (P=0.004). Operation time and warm/cool ischemia time were longer in the multiple-renal-arteries group. However, estimated blood loss, delayed graft function, acute rejection and flow rate of arcuate artery were similar in both groups, the same as serum creatinine and serum creatinine clearance rate on day 7, 1 month and 3 month post-operation. It was shown by repeated measures ANOVA that graft with multiple arteries didn't affect the tendency of renal function at early time post-operation. Comprehending the character of renal artery and accurate treatment of multiple artery anastomosis are critical for the effect of the living kidney transplantation.

  7. Effect of volume expansion on systemic hemodynamics and central and arterial blood volume in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Henriksen, Jens Henrik Sahl

    1995-01-01

    , and arterial pressure were determined before and during a volume expansion induced by infusion of a hyperosmotic galactose solution. RESULTS: During volume expansion, the central and arterial blood volume increased significantly in patients with class A and controls, whereas no significant change was found...... in patients with either class B or class C. Conversely, the noncentral blood volume increased in patients with class B and C. In both patients and controls, the cardiac output increased and the systemic vascular resistance decreased, whereas the mean arterial blood pressure did not change significantly......BACKGROUND & AIMS: Systemic vasodilatation in cirrhosis may lead to hemodynamic alterations with reduced effective blood volume and decreased arterial blood pressure. This study investigates the response of acute volume expansion on hemodynamics and regional blood volumes in patients with cirrhosis...

  8. Does complete renal denervation translate into superior clinical outcomes? Lessons learned from denervation of accessory renal arteries

    OpenAIRE

    Mendelsohn, Farrell O.

    2014-01-01

    Pre-clinical studies of renal denervation would suggest that the extent of renal nerve injury correlates with outcomes. The “completeness” of renal nerve injury following renal denervation correlates with treatment-based variables such as the depth of ablation, the number of ablations along the length of the artery, and the number of renal arteries successfully ablated. Renal denervation techniques targeting only main renal arteries may lead to suboptimal results in patients with accessory re...

  9. Renal Infarction Caused by Spontaneous Renal Artery Dissection: Treatment with Catheter-Directed Thrombolysis and Stenting

    International Nuclear Information System (INIS)

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Ki Cheon

    2009-01-01

    Spontaneous renal artery dissection (SRAD) is rare and presents a diagnostic and therapeutic challenge. We report a case of a 36-year-old man who had an SRAD-complicated renal infarction. The patient experienced severe unilateral flank pain. Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. The patient was treated with catheter-directed thrombolysis and frenal artery stenting.

  10. Renal artery pulsatility index and renal volume: Normal fetuses versus growth-retarded fetuses

    International Nuclear Information System (INIS)

    Lee, Kyung Soon; Woo, Bock Hi

    2001-01-01

    To evaluate the blood flow velocity waveform of the renal artery and renal volume of growth-retarded fetuses and to compare them with those of normal fetuses. Pulsatility index of the renal artery and renal volume measured by three-dimensional ultrasonography were obtained from seventy eight normal fetuses at the gestational age from twenty five to thirty nine weeks and eighteen intrauterine growth retarded fetuses whose weight was below ten percentile at birth. We studied changes of the pulsatility index of the renal artery and renal volume according to the gestational age and compared with those of growth-retarded fetuses. Pulsatility index (PI) of the fetal renal artery decreased throughout the gestational period (r=0.703, p<0.0001). In growth-retarded fetuses, despite of abnormal doppler velocity waveform of the middle cerebral artery, which was showing fetal hypoxia, the renal PI was not increased significantly. The fetal renal volume increased throughout the gestational period (r=0.834, p<0.0001) whereas in growth-retarded fetuses, all renal volume was below fifth percentile of normal fetuses. In growth-retarded fetuses, fetal renal volume was decreased significantly without change of the renal vascular flow. Therefore, the fetal renal volume measured by three-dimensional ultrasonography may be a helpful parameter in the diagnosis of growth-retarded fetuses.

  11. Renal artery pulsatility index and renal volume: Normal fetuses versus growth-retarded fetuses

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soon; Woo, Bock Hi [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2001-06-15

    To evaluate the blood flow velocity waveform of the renal artery and renal volume of growth-retarded fetuses and to compare them with those of normal fetuses. Pulsatility index of the renal artery and renal volume measured by three-dimensional ultrasonography were obtained from seventy eight normal fetuses at the gestational age from twenty five to thirty nine weeks and eighteen intrauterine growth retarded fetuses whose weight was below ten percentile at birth. We studied changes of the pulsatility index of the renal artery and renal volume according to the gestational age and compared with those of growth-retarded fetuses. Pulsatility index (PI) of the fetal renal artery decreased throughout the gestational period (r=0.703, p<0.0001). In growth-retarded fetuses, despite of abnormal doppler velocity waveform of the middle cerebral artery, which was showing fetal hypoxia, the renal PI was not increased significantly. The fetal renal volume increased throughout the gestational period (r=0.834, p<0.0001) whereas in growth-retarded fetuses, all renal volume was below fifth percentile of normal fetuses. In growth-retarded fetuses, fetal renal volume was decreased significantly without change of the renal vascular flow. Therefore, the fetal renal volume measured by three-dimensional ultrasonography may be a helpful parameter in the diagnosis of growth-retarded fetuses.

  12. EFFECTS OF PARENT ARTERY SEGMENTATION AND ANEURISMALWALL ELASTICITY ON PATIENT-SPECIFIC HEMODYNAMIC SIMULATIONS

    Institute of Scientific and Technical Information of China (English)

    CHEN Jia-liang; DING Guang-hong; YANG Xin-jian; LI Hai-yun

    2011-01-01

    It is well known that hemodynamics and wall tension play an important role in the formation,growth and rupture of aneurysms.In the present study,the authors investigated the influence of parent artery segmentation and aneurismal-wall elasticity on patient-specific hemodynamic simulations with two patient-specific eases of cerebral aneurysms.Realistic models of the aneurysms were constructed from 3-D angiography images and blood flow dynamics was studied under physiologically representative waveform of inflow.For each aneurysm three computational models were constructed:Model 1 with more extensive upstream parent artery with the rigid arterial and aneurismal wall,Model 2 with the partial upstream parent artery with the elastic arterial and aneurismal wall,Model 3 with more extensive upstream parent artery with the rigid wall for arterial wall far from the aneurysm and the elastic wall for arterial wall near the aneurysm.The results show that Model 1 could predict complex intra-aneurismal flow patterns and wall shear stress distribution in the aneurysm,but is unable to give aneurismal wall deformation and tension,Model 2 demonstrates aneurismal wall deformation and tension,but fails to properly model inflow pattern contributed by the upstream parent artery,resulting in local misunderstanding Wall Shear Stress (WSS) distribution,Model 3 can overcome limitations of the former two models,and give an overall and accurate analysis on intra-aneurismal flow patterns,wall shear stress distribution,aneurismal-wall deformation and tension.Therefore we suggest that the proper length of extensive upstream parent artery and aneuri-smal-wall elasticity should be considered carefully in establishing computational model to predict the intra-aneurismal hemodynamic and wall tension.

  13. Unraveling the relationship between arterial flow and intra-aneurysmal hemodynamics.

    Science.gov (United States)

    Morales, Hernán G; Bonnefous, Odile

    2015-02-26

    Arterial flow rate affects intra-aneurysmal hemodynamics but it is not clear how their relationship is. This uncertainty hinders the comparison among studies, including clinical evaluations, like a pre- and post-treatment status, since arterial flow rates may differ at each time acquisition. The purposes of this work are as follows: (1) To study how intra-aneurysmal hemodynamics changes within the full physiological range of arterial flow rates. (2) To provide characteristic curves of intra-aneurysmal velocity, wall shear stress (WSS) and pressure as functions of the arterial flow rate. Fifteen image-based aneurysm models were studied using computational fluid dynamics (CFD) simulations. The full range of physiological arterial flow rates reported in the literature was covered by 11 pulsatile simulations. For each aneurysm, the spatiotemporal-averaged blood flow velocity, WSS and pressure were calculated. Spatiotemporal-averaged velocity inside the aneurysm linearly increases as a function of the mean arterial flow (minimum R(2)>0.963). Spatiotemporal-averaged WSS and pressure at the aneurysm wall can be represented by quadratic functions of the arterial flow rate (minimum R(2)>0.996). Quantitative characterizations of spatiotemporal-averaged velocity, WSS and pressure inside cerebral aneurysms can be obtained with respect to the arterial flow rate. These characteristic curves provide more information of the relationship between arterial flow and aneurysm hemodynamics since the full range of arterial flow rates is considered. Having these curves, it is possible to compare experimental studies and clinical evaluations when different flow conditions are used. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Power doppler ultrasound findings of renal infarct after experimental renal artery occlusion: comparison with spiral CT

    International Nuclear Information System (INIS)

    Jung, Seung Eun; Shinn, Kyung Sub; Kim, Hak Hee; Mun, Seok Hwan; Lee, Young Joon; Lee, Bae Young; Choi, Byung Gil; Lee, Jae Mun; Lee, Hee Jeong

    1999-01-01

    To evaluate the efficacy of power Doppler ultrasonography (PDUS) in depicting renal infarction in rabbits during experimental renal segmental arterial occlusion, and to compare the results with those of CT scanning. In 28 rabbits weighing 2.5 4kg, the segmental renal artery was occluded through the left main renal artery by embolization with Ivalon (Nycomed, Paris, France). Power Doppler ultrasonography and spiral CT scanning were performed before and at 2, 5, 8, 15, and 24 hours, and 3 and 7 days after occlusion of the segmental renal artery. The location of infarcted areas and collaterals, as seen on PDUS and CT scans, was evaluated by two radiologists. In all cases, as seen on power Doppler ultrasonography, infarcted areas-when compared with normal parenchyma, clearly demonstrated wedge-shaped perfusion defects in the kidney. The location of the lesion closely corresponded to the location seen during CT scanning. After renal arterial occlusion, transiently congested capsular arteries, which were named 'capsular sign', were seen in 63% of rabbits in the two and five-hour groups. No significant cortical rim sign was demonstrated on power Doppler ultrasonography, though it was noted on spiral CT at 15 and 24 hours, and 3 and 7 days after renal arterial occlusion. Power Doppler ultrasonography was useful for the diagnosis of renal infarction. Congested capsular artery seen in the early stage of renal infarction might be a characteristic finding of this condition, as seen on power Doppler ultrasonography

  15. Renal hemodynamic changes with aging: a preliminary study using CT perfusion in the healthy elderly.

    Science.gov (United States)

    Zhao, Hong; Gong, Jingshan; Wang, Yan; Zhang, Zuoquan; Qin, Peixin

    2010-01-01

    To investigate renal blood flow perfusion parameter changes associated with aging using multislice spiral computed tomography (CT). This prospective study was approved by the institute's ethics committee for clinical study and written informed consent was obtained from all subjects. Forty-two consecutive patients who underwent abdominal CT without obvious renal abnormality at plain scanning were enrolled in this study. The renal perfusion scan was carried out using 16-slice spiral CT. The Pearson correlation coefficient was used to examine the correlation between perfusion parameter changes with aging. In both the cortex and medulla, blood flow (BF) and blood volume (BV) were negatively correlated with age, while time-to-peak (TTP) value and mean transit time (MTT) showed a positive correlation with age. Changes in BF, TTP, and MTT were found to have a statistically significant correlation with age in both the cortex and medulla, while the correlation between BV and age showed no statistical significance. It is feasible to assess renal hemodynamics changes with aging in the elderly using the current clinically available CT perfusion imaging technology in vivo. It may be helpful in the management of aged patients to familiarize with the renal hemodynamics changes in clinical work-up. Copyright 2010 Elsevier Inc. All rights reserved.

  16. Anatomic variations of the renal vessels: focus on the precaval right renal artery.

    Science.gov (United States)

    Bouali, Ourdia; Labarre, David; Molinier, François; Lopez, Raphaël; Benouaich, Vincent; Lauwers, Frédéric; Moscovici, Jacques

    2012-07-01

    The aim of this study was to determine the prevalence of precaval right renal artery and to investigate the distribution of renal arteries and veins. We discuss a theory of development of renal vascular variants. We retrospectively reviewed 120 arterial phase contrast material-enhanced spiral computerized tomography scans of the abdomen (1- to 2-mm section thickness) performed during a two-month period. Forty percent of the study group (48 patients) had one artery and one vein on each side, with typical course. There was a 9.17% prevalence of precaval right renal artery: 10 patients had a lower pole accessory artery in precaval position and one patient had the main and the accessory arteries that pass anterior to the inferior vena cava. In these cases, associated variations of renal vessels were higher than in the patients without precaval artery variant. There were multiple arteries in 28.3% of the right kidneys and in 26.7% of the left ones. Variants of the right renal vein consisted in multiple veins in 20% (24 cases). We detected no case of multiple left renal veins, but we described variations of its course (circum- or retroaortic vein) in 9.17% (11 cases). Twenty-six patients (21.7%) had associated variations of the renal pedicle. The current technical support allows for a minimally invasive study of vessels anatomy. In our study the prevalence of a precaval right renal artery appears to be higher than previously reported (9.17%). Knowledge on anatomical variations of right renal artery and associated renal vessels variations has major clinical implications.

  17. Pulmonary hemodynamics and gas exchange in off pump coronary artery bypass grafting.

    Science.gov (United States)

    Vedin, Jenny; Jensen, Ulf; Ericsson, Anders; Samuelsson, Sten; Vaage, Jarle

    2005-10-01

    To investigate the influence of cardiopulmonary bypass on pulmonary hemodynamics and gas exchange. Low risk patients admitted for elective coronary artery bypass grafting were randomized to either on (n=25) or off pump (n=25) surgery. Central hemodynamics, gas exchange, and venous admixture were studied during and up to 20 h after surgery. There was no difference in pulmonary vascular resistance index (P=0.16), right ventricular stroke work index (P>0.2), mean pulmonary artery pressure (P>0.2) or pulmonary capillary wedge pressure (P>0.2) between groups. Soon after surgery there was a tendency towards higher cardiac index (P=0.07) in the off pump group. Arterial oxygen tension (P>0.2), hematocrit (P>0.2), venous admixture (P>0.2), and arterial-venous oxygen content difference (P=0.12) did not differ between groups. This prospective, randomized study showed no difference in pulmonary hemodynamics, pulmonary gas exchange, and venous admixture, in low risk patients undergoing off pump compared to on pump coronary artery bypass surgery.

  18. Advances in radiological imaging of the renal arteries and veins

    International Nuclear Information System (INIS)

    Miao Xiaofan; Tang Lijun; Yang Bing

    2013-01-01

    Familiarity with the normal anatomy of the renal vessels and common variants is of particular importance for the operator who performs renal transplantation or therapeutic interventions in the renal vessels. Because of the recent major advances in multislice spiral computed tomography angiography (MSCTA) techniques, our ability has been considerably improved to determine the patterns and characters of renal arteries and veins. This article summarizes the research situation and progress in the area of renal vessel imaging anatomy. Some regularity in the distribution of renal vessel positions, dimensions and variations among patients who received MSCTA examinations, and these anatomical measurements are of great value for clinical diagnosis and treatment. (authors)

  19. Analysis of hemodynamic characteristics in anastomotic sites of femoral artery implantation

    Energy Technology Data Exchange (ETDEWEB)

    Roh, H.W. [Graduate School, Soongsil University, Seoul (Korea); Suh, S.H. [SoongsSil University, Seoul (Korea); Yoo, S.S. [Hankuk Aviation University, Kyonggi-do (Korea); Kim, D.I.; Lee, B.B. [Samsung Medical Center (Korea)

    1998-11-01

    The objective of the present study is to obtain information on the hemodynamic characteristics in the anastomotic sites of femoral artery through the vascular implantation. Three dimensional steady and physiological blood flows in the femoral artery are simulated using the finite volume method. The geometrical shape of the anastomotic sites is made based on the vascular anatomy of a white rabbit. Wall shear stress distributions in the anastomotic sites for the physiological flow are compared with those for steady flow. Blood flow phenomena in the anastomotic sites of the femoral artery are discussed extensively. (author). 9 refs., 11 figs., 1 tab.

  20. Valutazione morfo-funzionale in pazienti ipertesi con stenosi dell'arteria renale; Correlazioni tra angiografia e scintigrafia dinamica. Morpho-functional evaluation in hypertensive patients with renal artery stenosis; Correlations between angiography and radionuclide renography

    Energy Technology Data Exchange (ETDEWEB)

    Cuocolo, A; Celentano, L; Nappi, A [Naples Univ. (Italy). Ist. di Scienze Radiologiche; Neumann, R D; Salvatore, M [Naples Univ. (Italy). Cattedra di Medicina Nucleare

    1991-01-01

    Renovascula hypertension is the most important and common cause of secondary hypertension. We studied 10 patients with arterial hypertension and different degrees of renal artery stenosis to assess the usefulness of dynamic radionuclide renography in evaluating renal perfusion and funcion, and to compare funcional radionuclide results to the morphological findings of renal angiography. Computer-assisted dynamic renal with {sup 00m}Tc diethylenetriaminepentaacetic acid (DTPA) and {sup 131}I orthoiodohippurate (OIH), and renal artheriography were also employed in all patients. In all patients, radionuclide results matched angiography findings in quality. In particular, 3 patients with hemodynamical insignificant renal artery stenosis exhibited normal perfusion and function at dynamic radionuclide renography. Seven patients had significant renal artery stenosis and associated functional changes at dynamic radionuclide renography. Quantitative comparison of all patients showed a significant correlation (r=0.866, p<0.001) between the degree of renal artery stenosis, quantified as the percentage of narrowing as compared to adjacent/contralateral normal vessel diameter, and the results of split renal function, as assessed during OIH studies and expressed per kidney as a percentage of the net total counts of both kidneys. In conclusion, our results demonstrated dynamic radionuclide renography to be a valuable secondary to renal artery stenosis in hypertensive patients, providing complementary results to arteriography.

  1. Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome.

    Science.gov (United States)

    Unlu, Murat; Orguc, Sebnem; Serter, Selim; Pekindil, Gokhan; Pabuscu, Yuksel

    2007-01-01

    To investigate the anatomic and hemodynamic properties of testicular venous drainage and its effects on varicocele formation and reflux using color Doppler ultrasound (US) with emphasis on renal vein entrapment syndrome. Upper abdominal and scrotal US examinations of 35 varicocele patients and 35 healthy male subjects were performed in the supine position during rest, during a Valsalva maneuver and in the erect position. The aortomesenteric angle and distance (AMA and AMD, respectively), peak mean velocities (PVs) and diameters of different segments of renal veins, testicular vein diameters and duration of flow inversion were measured. In the varicocele group, the lateral segment of the left renal vein (LRV) had a larger diameter and slower PV, and the medial segment of the LRV had a smaller diameter and faster PV. The diameter of the dominant draining vein correlated with the PV of the medial and lateral segments of the LRV, whereas there was no correlation between the diameter of the dominant draining vein and the diameters of the right renal vein (RRV) and the lateral segment of the LRV or the PV of the RRV. The duration of flow inversion correlated with the diameter and PV of the medial segment of the LRV. No correlation between the diameters and PVs of the RRV and the lateral segment of the LRV was detected. The decreases in the AMA, AMD, diameter of the medial segment of the LRV and PV of the lateral segment of the LRV, and the increases in the PV of the medial segment of the LRV and the diameter of the lateral segment of the LRV in varicocele patients in all positions suggest the entrapment or impingement of the left renal vein between the aorta and the superior mesenteric artery. This has been defined as the "nutcracker phenomenon", which is known to affect varicocele formation.

  2. Does Flexible Arterial Tubing Retain More Hemodynamic Energy During Pediatric Pulsatile Extracorporeal Life Support?

    Science.gov (United States)

    Wang, Shigang; Kunselman, Allen R; Ündar, Akif

    2017-01-01

    The objective of this study was to evaluate the hemodynamic performance and energy transmission of flexible arterial tubing as the arterial line in a simulated pediatric pulsatile extracorporeal life support (ECLS) system. The ECLS circuit consisted of a Medos Deltastream DP3 diagonal pump head, Medos Hilite 2400 LT oxygenator, Biomedicus arterial/venous cannula (10 Fr/14 Fr), 3 feet of polyvinyl chloride (PVC) arterial tubing or latex rubber arterial tubing, primed with lactated Ringer's solution and packed red blood cells (hematocrit 40%). Trials were conducted at flow rates of 300 to 1200 mL/min (300 mL/min increments) under nonpulsatile and pulsatile modes at 36°C using either PVC arterial tubing (PVC group) or latex rubber tubing (Latex group). Real-time pressure and flow data were recorded using a custom-based data acquisition system. Mean pressures and energy equivalent pressures (EEP) were the same under nonpulsatile mode between the two groups. Under pulsatile mode, EEPs were significantly great than mean pressure, especially in the Latex group (P tubing retained more hemodynamic energy passing through it under pulsatile mode while mean pressures and pressure drops across the ECLS circuit were similar between PVC and latex rubber arterial tubing. Further studies are warranted to verify our findings. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  3. In vivo MR perfusion imaging of renal artery stenosis

    International Nuclear Information System (INIS)

    Powers, T.; Lorenz, C.H.; Bain, R.; Holburn, G.; Price, R.R.

    1989-01-01

    Various techniques have been developed for noninvasive evaluation of renal blood flow. More important in the assessment of potential renal ischemia may be actual perfusion of the nephron mass. MR pulse sequences have been devised that allow perfusion imaging (PI) in a dog model of renal artery stenosis. Unilateral renal artery stenosis was created in mongrel dogs and quantitation of renal blood flow was obtained with radioactive microspheres. Perfusion imaging was performed on a 1.5-T system to obtain the apparent diffusion coefficient. During initial studies, it was found that the usual gradient factor used in brain PI was too high for renal studies; a factor of < 50 was found to be optimal. Additionally, respiratory gating with acquisition at end expiration was necessary to prevent renal motion. Recent studies have shown that PI reflects the asymmetry of flow in this model

  4. Treatment of non-neoplastic renal hemorrhage with segmental embolization of renal artery

    International Nuclear Information System (INIS)

    Zhu Bing

    2007-01-01

    Objective: To explore the value of segmental embolization of renal artery in dealing with non- neoplastic renal hemorrhage. Methods: Four cases of non-neoplastic hemorrhage, including 2 with bleeding after renal acupuncture biopsy, 2 with bleeding after nephrolithotomy and 1 with congenital renal arteriovenous malformation, were treated with superselective segmental embolization of renal artery. 2 were embolized with coil, 1 with alcohol plus coil and 1 with PVA parcels. Results: Hematuria disappeared in 1-3 days. There was no recurrence in 7-45 months follow up and no complications induced by embolization. Conclusion: It is a safe and reliable therapy to treat non-neoplastic renal hemorrhage with segmental embolization of renal artery. (authors)

  5. Frequency and predictors of renal artery stenosis in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Shah, S.S.; Hafeezullah, M.

    2010-01-01

    Background: Renal artery stenosis (RAS) is a common finding in patients undergoing coronary angiography. We designed this study to look for the frequency and any predictors of renal artery stenosis in patients with coronary artery disease (CAD). Methods: A total of 201 consecutive patients with CAD confirmed by coronary angiography underwent an abdominal aortogram in the same sitting to screen for RAS. Patient demographics and co-morbidities were analysed for any association with RAS. Results: Forty-one of the patients were female (20.4%); ninety patients were hypertensive (44.8%); 49 patients (24.4%) were smokers; 19 patients (9.5%) had renal insufficiency; 88 patients (43.8%) had high cholesterol levels; 44 patients (21.9%) were diabetic. Thirty-two patients (15.9%) had single coronary artery disease, 59 patients (29.4%) had two vessel disease, and 110 patients (54.7%) had three vessel disease. Significant renal artery stenosis (less or equal to 50% stenosis) was present in 26 patients (12.9%). Among the variables studied, only female gender was found to be associated with a higher frequency of renal artery stenosis (24.39% vs 10.0%, p=0.01). Conclusions: The frequency of renal artery stenosis in patients with coronary artery disease is 12.9%. Female gender is associated with a higher frequency of renal artery stenosis in patients with CAD. (author)

  6. A large unilateral renal artery aneurysm in a young child

    International Nuclear Information System (INIS)

    Robitaille, P.; Lord, H.; Dubois, J.; Rypens, F.; Oligny, L.L.

    2004-01-01

    The case of a 13-month-old boy with fibromuscular dysplasia (FMD) presenting with a large saccular aneurysm of the left renal artery and renovascular hypertension is reported. Renal and intrarenal arteries showed numerous small aneurysms alternating with stenoses. All arterial lesions were localized to the left kidney. After left nephrectomy, the patient's blood pressure normalized. Histopathologic examination of the arteries disclosed changes typical of medial fibroplasias, the most frequently described form of FMD in children. This diagnosis is rewarding as it represents a surgically curable cause of severe hypertension. (orig.)

  7. Intra-renal localised reno-renal collaterals in the dog after tying of the main renal artery

    International Nuclear Information System (INIS)

    Rosenbusch, G.; Vincent, J.; Douveren, W. van; Sktonicki, S.; Arts, T.H.M.; Katholieke Univ. Nijmegen; Katholieke Univ. Nijmegen

    1984-01-01

    In 7 kidneys of 6 dogs one of the main stem of the renal artery was ligated. The development of the renorenal collaterals could be followed in 5, as two dogs died after the operation. In all cases intrarenal collaterals could be demonstrated, even in the postoperative dead dogs. The vessels responsible for the collateral circulation are preformed interarterial anastomoses, belonging to the extraglomerular arterial system. From the results of these and former experimental studies it can be concluded, that the renal artery of the dog when entering the renal sinus cannot be regarded as an anatomic, but at most as a functional end artery. (orig.) [de

  8. Intra-renal localised reno-renal collaterals in the dog after tying of the main renal artery

    Energy Technology Data Exchange (ETDEWEB)

    Rosenbusch, G.; Vincent, J.; Douveren, W. van; Sktonicki, S.; Arts, T.H.M.

    1984-01-01

    In 7 kidneys of 6 dogs one of the main stem of the renal artery was ligated. The development of the renorenal collaterals could be followed in 5, as two dogs died after the operation. In all cases intrarenal collaterals could be demonstrated, even in the postoperative dead dogs. The vessels responsible for the collateral circulation are preformed interarterial anastomoses, belonging to the extraglomerular arterial system. From the results of these and former experimental studies it can be concluded, that the renal artery of the dog when entering the renal sinus cannot be regarded as an anatomic, but at most as a functional end artery.

  9. Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis.

    Science.gov (United States)

    Bulut, Mehmet Deniz; Alpayci, Mahmut; Şenköy, Emre; Bora, Aydin; Yazmalar, Levent; Yavuz, Alpaslan; Gülşen, İsmail

    2016-02-15

    BACKGROUND Because loss of cervical lordosis leads to disrupted biomechanics, the natural lordotic curvature is considered to be an ideal posture for the cervical spine. The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. The aim of this study was to compare the vertebral artery values between subjects with and without loss of cervical lordosis. MATERIAL AND METHODS Thirty patients with loss of cervical lordosis and 30 controls matched for age, sex, and body mass index were included in the study. Sixty vertebral arteries in patients with loss of cervical lordosis and 60 in controls without loss of cervical lordosis were evaluated by Doppler ultrasonography. Vertebral artery hemodynamics, including lumen diameter, flow volume, peak systolic velocity, end-diastolic velocity, and resistive index, were measured, and determined values were statistically compared between the patient and the control groups. RESULTS The means of diameter (p=0.003), flow volume (p=0.002), and peak systolic velocity (p=0.014) in patients were significantly lower as compared to controls. However, there was no significant difference between the 2 groups in terms of the end-diastolic velocity (p=0.276) and resistive index (p=0.536) parameters. CONCLUSIONS The present study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity. Further studies are required to confirm these findings and to investigate their possible clinical implications.

  10. Three-dimensional renal CT angiography for guiding segmental renal artery clamping during laparoscopic partial nephrectomy

    International Nuclear Information System (INIS)

    Xu, Yi; Shao, Pengfei; Zhu, Xiaomei; Lv, Qiang; Liu, Wangyan; Xu, Hai; Zhu, Yinsu; Yang, Guangyu; Tang, Lijun; Yin, Changjun

    2013-01-01

    Aim: To evaluate the effectiveness of three-dimensional (3D) renal computed tomography angiography (CTA) in guiding segmental renal artery clamping during laparoscopic partial nephrectomy (LPN). Materials and methods: Forty-three patients with renal tumours undergoing renal CTA before LPN were retrospectively enrolled in this study. 3D arteriogram reconstructed images were created to identify the renal tumour-supplying arteries. The number and location of these targeted vessels were annotated on 3D images preoperatively and compared with the clamped vessels during LPN. The consistency between target vessels annotated at CTA and clamped arteries at LPN was compared both using a patient-based analysis and vessel-based analysis. The χ 2 test was applied to analyse the influence of tumour size, location, and growth pattern on the number of clamped segmental renal branches. Results: On patient-based analysis, the number of targeted vessels was consistent with the clamped vessels during LPN in 33 of 43 patients. On vessel-based analysis, 56 of 65 target vessels annotated at CTA were clamped during LPN. More segmental renal branches (p = 0.04) were clamped in patients with tumours of larger size. Tumour location and growth pattern had no association with the number of clamped segmental branches during LPN. Conclusion: High-quality CTA images and 3D reconstruction images can detect detailed information of tumour-supplying arteries to renal tumours. 3D renal CTA is an effective way to guide segmental renal artery clamping during LPN

  11. [Aortic dissection spread to the renal arteries: role of renal volumetry after angioplasty].

    Science.gov (United States)

    Vautrin, E; Thony, F; Chavanon, O; Hannachi, I; Barone-Rochette, G; Pierre, H; Baguet, J-P

    2012-06-01

    Type A or B aortic dissection can extend to renal arteries, causing a renal ischemia which treatment is usually endovascular. The aim of our study is to show the interest of the renal volumetry in the follow-up of these patients. Twenty-two patients (16 men, mean age 63.4±11.8years, BMI 25.2±3.4kg/m(2)) with a type A or B aortic dissection spread to one or to both renal arteries and followed at Grenoble university hospital were consecutively included. All patients underwent renal angiography with aorto-renal pressure gradients measurements and follow-up by renal volumetry (scanner Siemens(®)). A renal ischemia was defined by a decrease of 20% or more of the volumetry. Sixteen patients (73%) were hypertensive before the aortic dissection among which ten (62%) were treated. Eight patients (36%) have a significant renal pressure gradient among which five (62%) underwent renal endovascular therapy. The renal volumetry of these five patients remained unchanged while six of 17 patients (36%) without angioplasty have a decreasing volumetry. Renal volumetry appeared an effective and attractive option for the follow-up of the patients with aortic dissection spread to the renal arteries. These results should be taken into account to put the indication of an endovascular treatment. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  12. Measurement system for an in-vitro characterization of the biomechanics and hemodynamics of arterial bifurcations

    International Nuclear Information System (INIS)

    Suárez-Bagnasco, D; Balay, G; Negreira, C A; Cymberknop, L; Armentano, R L

    2013-01-01

    Arterial behaviour in-vivo is influenced, amongst other factors, by the interaction between blood flow and the arterial wall endothelium, and the biomechanical properties of the arterial wall. This interaction plays an important role in pathogenic mechanisms of cardiovascular diseases such as atherosclerosis and arteriosclerosis. To quantify these interactions both from biomechanical and hemodynamical standpoints, a complete characterization and modelling of the arterial wall, blood flow, shear wall and circumferential wall stresses are needed. The development of a new multi-parameter measurement system (distances, pressures, flows, velocity profiles, temperature, viscosity) for an in-vitro characterization of the biomechanics and hemodynamics in arterial bifurcations (specially in carotid bifurcations) is described. This set-up represents an improvement relative to previous set-ups developed by the group FCIEN-FMED and is presently under development. Main subsystems interactions and environment-system interactions were identified and compensated to improve system's performance. Several interesting problems related with signal acquisition using a variety of sensors and some experimental results are shown and briefly discussed. Experimental data allow construction of meshes and parameter estimation of the biomechanical properties of the arterial wall, as well as boundary conditions, all suitable to be employed in CFD and FSI numerical simulation.

  13. Renal artery stenosis after radiotherapy for Ewing's sarcoma

    International Nuclear Information System (INIS)

    Tacconi, S.; Bieri, S.

    2008-01-01

    Background: the fact that therapeutic irradiation can induce significant stenosis in the arteries of the head, neck, and chest, as welt as in the aorta and the iliac arteries, is familiar in daily practice and well documented in the literature. By contrast, radiation-induced renal artery stenosis seems to be a less widely known complication. Patients and methods: the sudden onset of medically refractory arterial hypertension and coma in a 27-year-old man is reported, who had been treated at age 20 with chemotherapy and radiotherapy for Ewing's sarcoma in the lumbar region. This treatment had been performed at the hospital of Sion, Switzerland in 2001. Also, the relevant literature from 1965 to 2007 is reviewed to underscore various aspects of this problem and to demonstrate the clinical relevance of renal artery stenosis as a potential long-term sequela of radiotherapy. Conclusion: radiation-induced renal artery stenosis has only rarely been described in the literature, but arterial hypertension due to radiation-induced renal artery stenosis is a serious long-term sequela that can appear at a latency of up to 20 years after treatment. The paucity of reports presumably reflects the lesser frequency of radiotherapy for retroperitoneal tumors as compared to head-and-neck cancers, as well as lower awareness of the problem due to diagnostic bias in the era before CT and MRI were in routine use: at that time, carotid artery stenosis was easy to diagnose by ultrasonography, while radiation-induced renal artery stenosis, whose real incidence may well be higher, probably often went undetected. Thus, when a patient with a history of abdominal or retroperitoneal radiotherapy unexpectedly develops intractable hypertension, radiation-induced renal artery stenosis must be included in the differential diagnosis. (orig.)

  14. Transcatheter arterial embolization for congenital renal arteriovenous malformation

    International Nuclear Information System (INIS)

    Zhou Jun; Hu Tingyang; Yuan Jianhua; Yu Wenqiang

    2008-01-01

    Objective: To evaluate the effectiveness of transcatheter arterial embolization for congenital renal arteriovenous malformation. Methods: Seven cases of congenital renal arteriovenous malformation causing gross hematuria were retrospectively studied. All of 7 cases were demonstrated by means of angiography and then the catheter was placed superselectively into the involved arterial end of the malformation undertaking embolization with gelfoam, dehydrated ethanol, coils, etc. Results: All the malformations of the 7 cases were successfully embolized with stoppage of gross hematuria within 24 hours. No serious complications occurred except lumbago, fever, gastrointestinal reaction for one week. There was no recurrence of haematuria and the renal function was also normal in all cases during the follow-up for 36 to 98 months. Conclusions: Transcatheter renal arterial angiography and embolization are the important and effective management for the diagnosis and treatment of congenital renal arteriovenous malformation. (authors)

  15. Kissing stenting of aorto-ostial lesions in juxtaposed renal arteries

    OpenAIRE

    Hasija, Pradeep; Chadha, Davinder; Kalra, Ravi

    2014-01-01

    Percutaneous angioplasty with or without stenting has become an established procedure for treatment of renal artery stenosis for control of hypertension or progressive renal dysfunction. Anatomic variation of renal arteries is common with dual blood supply of unilateral kidney noted in almost 25% of the general population. Renal angioplasty of these anatomic variants of renal arteries is challenging. We present an unusual case of juxtaposed renal arteries with aorto-ostial lesion where direct...

  16. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients.

    Science.gov (United States)

    Ozkan, Uğur; Oğuzkurt, Levent; Tercan, Fahri; Kizilkiliç, Osman; Koç, Zafer; Koca, Nihal

    2006-12-01

    To determine angiographically the origins and variations of renal arteries. The study included 855 consecutive patients (163 females, 692 males; mean age, 61 years) living in the Cukurova region of Turkey, who underwent either aortofemoropopliteal (AFP) angiography for the investigation of peripheral arterial disease, or renal angiography for renovascular hypertension, and were prospectively evaluated. Renal arteries were visualized by non-selective catheterization during AFP angiography and by selective or non-selective catheterization during renal angiography. Locations of renal artery origins and renal artery variations, including the presence of extra renal arteries and division patterns were analyzed on angiograms. The origin of main renal arteries off the aorta was between the upper margin of L1 and lower margin of L2 vertebra in 98% of the patients, and in 74%, this was the origin of extra renal arteries. The most common location for renal artery origin was the L1-L2 intervertebral disc level. A single renal artery was present in both kidneys in 76% of patients. Renal artery variations included multiple arteries in 24%, bilateral multiple arteries in 5%, and early division in 8% of the cases. Additional renal arteries on the right side were found in 16% and on the left side in 13% of cases. Of all the extra renal arteries, the percentage of accessory and aberrant renal arteries were 49% and 51%, respectively. Renal arteries originated between the first and the second lumbar vertebral levels in most patients. Extra renal arteries were quite frequent. These results should be kept in mind when a non-invasive diagnostic search is performed for renal artery stenosis, or when renal surgery related to renal arteries is performed.

  17. Dependence of renal blood flow on renal artery stenosis measured using CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Luedemann, Lutz [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Radiotherapy; Nafz, B.; Persson, P. [Charite - Universitaetsmedizin Berlin (Germany). Inst. for Vegetative Physiology; Elsner, F. [Krankenhaus am Urban, Berlin (Germany). Dept. of Anesthesiology; Grosse-Siestrup, C.; Meissler, M. [Charite - Universitaetsmedizin Berlin (Germany). Experimental Animal Unit; Gutberlet, M. [Charite - Universitaetsmedizin Berlin (Germany). Dept. of Diagnostic and Interventional Radiology; Univ. Leipzig/ Leipzig Heart Center (Germany). Dept. of Diagnostic and Interventional Radiology; Lengsfeld, P.; Voth, M. [Bayer-Schering Pharma AG, Berlin (Germany). Global Medical Affairs Diagnostic Imaging

    2011-03-15

    The present study investigates the suitability of computed tomography angiography (CTA) depicting the degree of renal artery stenosis for estimating renal blood flow (RBF) in a kidney. Materials and Methods: We investigated renal artery stenosis assessment by CTA in eight adult female hybrid pigs with an ultrasound probe implanted at the renal vein for RBF measurement. An inflatable metal-free cuff was placed around the renal artery to control the RBF. The RBF was then reduced in four steps. For each reduced RBF value and baseline RBF, CTA with a reconstructed slice thickness of 0.625 mm was performed in the arterial phase following injection of 80 ml of nonionic intravenous contrast medium. The radius of the stenotic and non-stenotic renal artery segment was measured in the reconstructed images. Results: A significant linear correlation (p < 0.0001) was found between the relative apparent stenosis (calculated as the ratio of the radii of the actual stenotic segment and a non-stenotic renal artery segment) and RBF. The linear regression yielded a slope of 0.57 and a y-axis of 24.1 %. A significant linear correlation (p < 0.0001) was also found between the relative true stenosis (the ratio of the radii of the actual stenotic segment and a non-stenotic renal artery segment at baseline) and the RBF. The linear regression yielded a slope of 0.67 and a y-axis of 13.8 %. Conclusion: The results show that the relative stenosis apparent on CTA differs from the true degree of renal artery stenosis. Nevertheless, the degree of renal artery stenosis determined by CTA provides a reliable estimate of the resulting RBF reduction. (orig.)

  18. Dependence of renal blood flow on renal artery stenosis measured using CT angiography

    International Nuclear Information System (INIS)

    Luedemann, Lutz; Nafz, B.; Persson, P.; Elsner, F.; Grosse-Siestrup, C.; Meissler, M.; Gutberlet, M.; Univ. Leipzig/ Leipzig Heart Center; Lengsfeld, P.; Voth, M.

    2011-01-01

    The present study investigates the suitability of computed tomography angiography (CTA) depicting the degree of renal artery stenosis for estimating renal blood flow (RBF) in a kidney. Materials and Methods: We investigated renal artery stenosis assessment by CTA in eight adult female hybrid pigs with an ultrasound probe implanted at the renal vein for RBF measurement. An inflatable metal-free cuff was placed around the renal artery to control the RBF. The RBF was then reduced in four steps. For each reduced RBF value and baseline RBF, CTA with a reconstructed slice thickness of 0.625 mm was performed in the arterial phase following injection of 80 ml of nonionic intravenous contrast medium. The radius of the stenotic and non-stenotic renal artery segment was measured in the reconstructed images. Results: A significant linear correlation (p < 0.0001) was found between the relative apparent stenosis (calculated as the ratio of the radii of the actual stenotic segment and a non-stenotic renal artery segment) and RBF. The linear regression yielded a slope of 0.57 and a y-axis of 24.1 %. A significant linear correlation (p < 0.0001) was also found between the relative true stenosis (the ratio of the radii of the actual stenotic segment and a non-stenotic renal artery segment at baseline) and the RBF. The linear regression yielded a slope of 0.67 and a y-axis of 13.8 %. Conclusion: The results show that the relative stenosis apparent on CTA differs from the true degree of renal artery stenosis. Nevertheless, the degree of renal artery stenosis determined by CTA provides a reliable estimate of the resulting RBF reduction. (orig.)

  19. Diagnostic use of angiotensin converting enzyme (ACE)-inhibited renal scintigraphy in the identification of selective renal artery stenosis in the presence of multiple renal arteries: A case report

    International Nuclear Information System (INIS)

    Morton, K.A.; Rose, S.C.; Haakenstad, A.O.; Handy, J.E.; Scuderi, A.J.; Datz, F.L.

    1990-01-01

    In patients with renovascular hypertension, it is unknown whether the angiotensin converting enzyme-(ACE) inhibited renal scan will identify stenosis of a segmental branch of a single renal artery or of an accessory artery where multiple renal arteries are present. Since multiple renal arteries may be present in approximately 25% of all individuals, it will be important to establish whether the ACE-inhibited renal scan is useful in this population. We report a case of stenosis involving a renal artery in a patient with multiple renal arteries, successfully identified by ACE-inhibited renal scintigraphy

  20. Variant anatomy of renal arteries in a Kenyan population.

    Science.gov (United States)

    Ogeng'o, Julius A; Masaki, Charles O; Sinkeet, Simeon R; Muthoka, Johnstone M; Murunga, Acleus K

    2010-01-01

    Variant anatomy of renal arteries is important in renal transplant, vascular reconstruction, and uroradiological procedures. The variations show ethnic and population differences. Data from Africans are scarce and altogether absent for Kenyans. To describe patterns of origin, trajectories and branching of renal arteries in a Kenyan population. Descriptive cross-sectional study conducted in the Department of Human Anatomy, University of Nairobi. Three hundred and fifty six kidneys from 178 cadavers and postmortem specimens were used in the study. Aorta, renal arteries and kidneys were exposed by dissection. Number, trajectories, level of branching, number of branches and point of entry into the kidney were recorded. Data was analyzed using SPSS version 16.0, and presented using macrographs, tables, and bar charts. Additional arteries occurred in 14.3% of the cases. In 82.4% of these, there was one additional artery. Fifty nine point five per cent of the double renal arteries were parallel and 7.1% crossed. Of the 305 single arteries, 76.4% showed hilar, 21.6% prehilar and 2% intraparenchymal branching. In the hilar branching, ladder type was present in 65% and fork type in 35%. Bifurcation and trifurcation were present in 59.6% and 33.1% respectively. Polar arteries were present in 16.9% cases. Over 14% of the Kenyan population may have additional renal arteries while more than 20% show early branching. Several trajectories and hilar branching patterns exist which renal transplant surgeons and radiologists should be aware of to avoid inadvertent vascular injury.

  1. [Ultrasonographic study of blood flow in the renal arteries of patients with arterial hypertension].

    Science.gov (United States)

    Makarenko, E S; Dombrovskiĭ, V I; Nelasov, N Iu

    2012-01-01

    Vascular duplex ultrasound duplex with simultaneous ECG registration was made to estimate the quantitative and time parameters of blood flow in the renal arteries with grade 1-2 arterial hypertension. There were increases in vascular resistance indices and acceleration phase index and a reduction in systolic phase index. There were correlations of the time parameters of blood flow in the renal arteries with age and lipidogram values.

  2. Percutaneous transluminal angioplasty in renal artery stenosis by takayasu's arteritis

    International Nuclear Information System (INIS)

    Zeon, Seok Kil; Kim, Ok Bae; Kim, Hyun Chul

    1984-01-01

    Authors want to report that PTA was an out-standing therapeutic method in treatment of renovascular hypertension by renal artery stenosis due to Takayasu's arteritis in an 18-years-old Korean female. Abdominal aortogram and bilateral renal arteriogram showed mild smooth narrowing of the mid abdominal aorta of 4cm length from origin of renal arteries, complete occlusion of left renal artery from it's origin with a few small collateral arteries and severe stenosis of proximal right renal artery. PTA of right renal artery was performed with Gruntzig Balloon dilatation catheter, and the patient's blood pressure was down to 120/80 from 220/130, stable for 8 months follow-up examination. Takayasu's arteritis is one of the most important cause of renovascular hypertension in Orientals. Multiple treatment modalities, such as steroid administration or variable surgical intervention, were attempted and limited response was presented. But PTA is a simple, cost-effective, repeated, and relatively complication-free method in treatment of renovascular hypertension due to Takayasu's arteritis, with an outstanding result, as authors case

  3. Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms

    OpenAIRE

    Lv, Nan; Wang, Chi; Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

    2016-01-01

    Background and Purpose The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA) aneurysms. Materials and Methods In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemo...

  4. Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment

    Directory of Open Access Journals (Sweden)

    Leonardou Polytimi

    2011-01-01

    Full Text Available Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS. Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS, whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS. 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.

  5. Time-dependent 3D simulations of the hemodynamics in a stented coronary artery

    International Nuclear Information System (INIS)

    Faik, Isam; Mongrain, Rosaire; Leask, Richard L; Rodes-Cabau, Josep; Larose, Eric; Bertrand, Olivier

    2007-01-01

    Stenting is becoming the major interventional cardiology procedure worldwide. However restenosis remains a major limitation to the effectiveness of stents. Alterations to the local hemodynamics in the stented segment of the artery could be a potential factor in the development of in-stent restenosis. The characterization of wall shear stress and of blood flow patterns in a stented artery is therefore necessary for a good understanding of the role of hemodynamics in the development of in-stent restenosis. We have used a time-dependent 3D numerical model of a stented coronary artery to study the characteristics of the blood flow and the shear stress distribution. Our results show that the presence of the stent produces significant secondary flow that is limited to an annulus in the near wall region. Low shear stress zones were localized in the vicinity of the struts while the tips of the struts exhibited high values of shear stress. These results support the hypothesis that local hemodynamics may affect the development of in-stent restenosis and could influence the choice of stent geometries for future stent designs

  6. Hemodynamic and arterial stiffness differences between African-Americans and Caucasians after maximal exercise.

    Science.gov (United States)

    Yan, Huimin; Ranadive, Sushant M; Heffernan, Kevin S; Lane, Abbi D; Kappus, Rebecca M; Cook, Marc D; Wu, Pei-Tzu; Sun, Peng; Harvey, Idethia S; Woods, Jeffrey A; Wilund, Kenneth R; Fernhall, Bo

    2014-01-01

    African-American (AA) men have higher arterial stiffness and augmentation index (AIx) than Caucasian-American (CA) men. Women have greater age-associated increases in arterial stiffness and AIx than men. This study examined racial and sex differences in arterial stiffness and central hemodynamics at rest and after an acute bout of maximal exercise in young healthy individuals. One hundred young, healthy individuals (28 AA men, 24 AA women, 25 CA men, and 23 CA women) underwent measurements of aortic blood pressure (BP) and arterial stiffness at rest and 15 and 30 min after an acute bout of graded maximal aerobic exercise. Aortic BP and AIx were derived from radial artery applanation tonometry. Aortic stiffness (carotid-femoral) was measured via pulse wave velocity. Aortic stiffness was increased in AA subjects but not in CA subjects (P < 0.05) after an acute bout of maximal cycling exercise, after controlling for body mass index. Aortic BP decreased after exercise in CA subjects but not in AA subjects (P < 0.05). Women exhibited greater reductions in AIx after maximal aerobic exercise compared with men (P < 0.05). In conclusion, race and sex impact vascular and central hemodynamic responses to exercise. Young AA and CA subjects exhibited differential responses in central stiffness and central BP after acute maximal exercise. Premenopausal women had greater augmented pressure at rest and after maximal aerobic exercise than men. Future research is needed to examine the potential mechanisms.

  7. Eigenimage filtering in the assessment of renal artery stenosis

    International Nuclear Information System (INIS)

    Windham, J.P.; Potvin, W.J.; Zhang, Y.; Farison, J.B.; Clarke, H.S.; Low, L.R.

    1986-01-01

    An image-filtering technique is applied in the evaluation of 13 dogs with surgically induced unilateral renal artery stenosis. A mathematical model representing first transit renal flow and glomerular filtration of Tc-99m DTPA is used to generate normal signature templates for vascular flow and cortex uptake from normal kidneys. These signatures are used to generate two weighting vectors where normal vascular flow and cortex uptake are desired processes and cortex uptake and vascular flow are interfering processes, respectively. From weighting vectors and kidney signature vectors, two indices are generated for quantitative analysis. Results of the study demonstrate that the technique is useful for evaluation of renal artery stenosis

  8. [Part II: basic hemodynamic monitoring and the use of pulmonary artery catheter].

    Science.gov (United States)

    Dias, Fernando Suparregui; Rezende, Ederlon; Mendes, Ciro Leite; Réa-Neto, Alvaro; David, Cid Marcos; Schettino, Guilherme; Lobo, Suzana Margareth Ajeje; Barros, Alberto; Silva, Eliézer; Friedman, Gilberto; Amaral, José Luiz Gomes do; Park, Marcelo; Monachini, Maristela; Oliveira, Mirella Cristine de; Assunção, Murillo Santucci César; Akamine, Nelson; Mello, Patrícia Veiga C; Pereira, Renata Andréa Pietro; Costa Filho, Rubens; Araújo, Sebastião; Félix Pinto, Sérgio; Ferreira, Sérgio; Mitushima, Simone Mattoso; Agareno, Sydney; Brilhante, Yuzeth Nóbrega de Assis

    2006-03-01

    Monitoring of vital functions is one of the most important tools in the management of critically ill patients. Nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. The intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. Despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using Pulmonary Artery Catheter still is one of the basic procedures in Critical Care. The aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the Use of Pulmonary Artery Catheter. Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty-five physicians and nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. Recommendations were made based on 55 questions about the use of central venous pressure, invasive arterial pressure, pulmonary artery catheter and its indications in different settings. Evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the PAC allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. However, the correct use of these tools is fundamental to achieve the benefits due to its use.

  9. Invasive assessment of renal artery atherosclerotic disease and resistant hypertension before renal sympathetic denervation.

    Science.gov (United States)

    Ribichini, Flavio; Pighi, Michele; Zivelonghi, Carlo; Gambaro, Alessia; Valvo, Enrico; Lupo, Antonio; Vassanelli, Corrado

    2013-01-01

    Renal sympathetic denervation (RSD) is emerging as a new therapeutic option for patients with severe hypertension refractory to medical therapy. The presence of a renal artery stenosis may be both a cause of secondary hypertension and a contraindication to RSD if a renal artery stent is implanted; therefore, the definition of the functional importance of a renal artery stenosis in a patient with refractory hypertension is crucial. We describe the imaging and functional intravascular assessment of an angiographically severe stenosis of the renal artery in a patient with severe refractory hypertension, by means of intravascular ultrasound (IVUS), and measurement of the translesional pressure gradient with a pressure wire. Pressure wire examination excluded any severity of the stenosis, and IVUS showed the presence of a dissected plaque that resolved spontaneously after 3 months of intensive medical therapy and high-dose statin. Subsequently the patient was treated with RSD, achieving a significant effect on blood pressure control. Intravascular imaging and functional assessment of renal artery anatomy in patients with atherosclerotic disease may prove particularly suited to patients with refractory hypertension and multilevel vascular disease who are considered for endovascular therapies, either renal artery stenting or RSD.

  10. Morphological characteristics of renal artery and kidney in rats.

    Science.gov (United States)

    Yoldas, Atilla; Dayan, Mustafa Orhun

    2014-01-01

    The gross anatomy and morphometry of the kidney and renal arteries were studied in the strains of laboratory rat: Sprague-Dawley (Sp) and Wistar (W) rats. Total of 106 three-dimensional endocasts of the intrarenal arteries of kidney that were prepared using standard injection-corrosion techniques were examined. A single renal artery was observed in 100% of the cases. The renal arteries were divided into a dorsal and a ventral branch. The dorsal and ventral branches were divided into two branches, the cranial and caudal branch. Renal arteries were classified into types I and II, depending on the cranial and caudal branches and their made of branching. The present study also showed that the right kidney was slightly heavier than the left one and that the kidney of the male was generally larger than that of the female. The mean live weights of the Sprague-Dawley and Wistar rats were found to be 258.26 ± 5.9 and 182.4 ± 19.05 g, respectively. The kidney weights were significantly correlated (P kidney weights were not found significantly correlated (P > 0.01) with the length of renal arteries.

  11. Superselective transcatheter renal arterial embolization for acute renal bleeding in patients with renal insufficiency: its clinical efficacy and safety

    International Nuclear Information System (INIS)

    Hu Tingyang; Zhou Bing; Yu Wenqiang; Luo Zuyan; Mao Yingmin; Chen Fanghong; Li Bo; Yuan Jianhua

    2010-01-01

    Objective: To discuss the clinical efficacy and complications of super selective renal arterial embolization in treating acute renal arterial bleeding in patients with renal insufficiency, and to evaluate the influence of the treatment on the renal function. Methods: During the period of January 2000 December 2009, super selective renal arterial embolization was performed in our institution for acute renal bleeding in 13 patients with renal insufficiency. The complete clinical and imaging materials of all patients were properly collected. The clinical effectiveness, the renal function, the extent of embolization and the complications were observed and the relationship between each other was analyzed. Results: The embolization procedure was successfully completed in all patients with a technical success rate of 100%. The mean embolized territory was 22% of a single kidney. Three days after the procedure, the hemoglobin level, hematocrit, blood pressure and heart rate were considerably improved in all patients. Compared to the corresponding preoperative data, all the differences were statistically significant (P 0.05), while the blood urea nitrogen was markedly decreased (P=0.011). Post embolization syndrome occurred in 5 patients and progressive aggravation of the renal function was observed in one patient, who had to receive hemodialysis finally. The embolized territory in patients occurring complications was larger than that in patients without occurring complications (U=1.500, P=0.006). Conclusion: Super selective renal arterial embolization is an effective and safe treatment for acute renal arterial bleeding in patients with renal insufficiency, the therapy will not significantly worsen the renal function. Appropriate and reasonable extent of embolization, as small as possible, is the key point for reducing the complications. (authors)

  12. Blood Pressure Response to Main Renal Artery and Combined Main Renal Artery Plus Branch Renal Denervation in Patients With Resistant Hypertension.

    Science.gov (United States)

    Fengler, Karl; Ewen, Sebastian; Höllriegel, Robert; Rommel, Karl-Philipp; Kulenthiran, Saaraaken; Lauder, Lucas; Cremers, Bodo; Schuler, Gerhard; Linke, Axel; Böhm, Michael; Mahfoud, Felix; Lurz, Philipp

    2017-08-10

    Single-electrode ablation of the main renal artery for renal sympathetic denervation showed mixed blood pressure (BP)-lowering effects. Further improvement of the technique seems crucial to optimize effectiveness of the procedure. Because sympathetic nerve fibers are closer to the lumen in the distal part of the renal artery, treatment of the distal main artery and its branches has been shown to reduce variability in treatment effects in preclinical studies and a recent randomized trial. Whether this optimized technique improves clinical outcomes remains uncertain. We report a 2-center experience of main renal artery and combined main renal artery plus branches renal denervation in patients with resistant hypertension using a multielectrode catheter. Twenty-five patients with therapy-resistant hypertension underwent renal sympathetic denervation with combined main renal artery and renal branch ablation and were compared to matched controls undergoing an ablation of the main renal artery only. BP change was assessed by ambulatory measurement at baseline and after 3 months. At baseline, BP was balanced between the groups. After 3 months, BP changed significantly in the combined ablation group (systolic/diastolic 24-hour mean and daytime mean BP -8.5±9.8/-7.0±10.7 and -9.4±9.8/-7.1±13.5 mm Hg, P renal artery and branches appears to improve BP-lowering efficacy and should be further investigated. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  13. Renal artery and parenchymal changes after renal denervation: assessment by magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Sanders, Margreet F.; Vink, Eva E.; Blankestijn, Peter J. [University Medical Center Utrecht, Department of Nephrology and Hypertension, PO Box 85500, Utrecht (Netherlands); Doormaal, Pieter Jan van; Habets, Jesse; Vonken, Evert-Jan; Leiner, Tim [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Beeftink, Martine M.A.; Verloop, Willemien L.; Voskuil, Michiel [University Medical Center Utrecht, Department of Cardiology, Utrecht (Netherlands); Bots, Michiel L. [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Fadl Elmula, Fadl Elmula M. [Oslo University Hospital, Department of Internal Medicine and Department of Cardiology, Ullevaal, Oslo (Norway); Hammer, Frank [Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Department of Radiology, Brussels (Belgium); Hoffmann, Pavel [Oslo University Hospital, Section for Interventional Cardiology, Department of Cardiology, Ullevaal, Oslo (Norway); Jacobs, Lotte; Staessen, Jan A. [University of Leuven, Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Leuven (Belgium); Mark, Patrick B.; Taylor, Alison H. [University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, Scotland (United Kingdom); Persu, Alexandre; Renkin, Jean [Universite Catholique de Louvain, Pole of Cardiovascular Research, Institut de Recherche Experimentale et Clinique, Brussels (Belgium); Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Cardiology Department, Brussels (Belgium); Roditi, Giles [Glasgow Royal Infirmary, Department of Radiology, Glasgow (United Kingdom); Spiering, Wilko [University Medical Centre Utrecht, Department of Vascular Medicine, Utrecht (Netherlands); Collaboration: on behalf of the European Network COordinating research on Renal Denervation (ENCOReD) Consortium

    2017-09-15

    Relatively little is known about the incidence of long-term renal damage after renal denervation (RDN), a potential new treatment for hypertension. In this study the incidence of renal artery and parenchymal changes, assessed with contrast-enhanced magnetic resonance angiography (MRA) after RDN, is investigated. This study is an initiative of ENCOReD, a collaboration of hypertension expert centres. Patients in whom an MRA was performed before and after RDN were included. Scans were evaluated by two independent, blinded radiologists. Primary outcome was the change in renal artery morphology and parenchyma. MRAs from 96 patients were analysed. Before RDN, 41 renal anomalies were observed, of which 29 mostly mild renal artery stenoses. After a median time of 366 days post RDN, MRA showed a new stenosis (25-49% lumen reduction) in two patients and progression of pre-existing lumen reduction in a single patient. No other renal changes were observed and renal function remained stable. We observed new or progressed renal artery stenosis in three out of 96 patients, after a median time of 12 months post RDN (3.1%). Procedural angiographies showed that ablations were applied near the observed stenosis in only one of the three patients. (orig.)

  14. Stents in Renal Artery Bifurcation Stenosis: A Case Report

    Directory of Open Access Journals (Sweden)

    Polytimi Leonardou

    2011-01-01

    Full Text Available A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The “kissing balloon” technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a “kissing” way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach.

  15. Stents in Renal Artery Bifurcation Stenosis: A Case Report

    Science.gov (United States)

    Leonardou, Polytimi; Pappas, Paris

    2011-01-01

    A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The “kissing balloon” technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a “kissing” way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach. PMID:21789043

  16. Renal Artery Stenosis Evaluated with 3D-Gd-Magnetic Resonance Angiography Using Transstenotic Pressure Gradient as the Standard of Reference. A Multireader Study

    International Nuclear Information System (INIS)

    Ekloef, H.; Ahlstrom, H.; Bostrom, A.; Bergqvist, D.; Andren, B.; Karacagil, S.; Nyman, R.

    2005-01-01

    Purpose: To evaluate 3D-Gd-magnetic resonance angiography (MRA) in detecting hemodynamically significant renal artery stenosis (RAS). Material and Methods: Thirty patients evaluated for atherosclerotic RAS by MRA and digital subtraction angiography (DSA) were retrospectively included. Standard of reference for hemodynamically significant RAS was a transstenotic gradient of 15 mmHg. DSA visualized 60 main renal arteries and 9 accessory arteries. Pressure gradient measurement (PGM) was available from 61 arteries. Three radiologists evaluated all examinations independently in a blinded fashion. Results: RAS was present in 26 arteries. On MRA, each reader identified 4 of 9 accessory renal arteries, a detection rate of 44%. The three readers correctly classified 22/25/22 of the 26 vessels with a significant gradient as >60% RAS and 31/25/32 of the 35 with a significant gradient as <60% RAS on MRA. Interobserver agreement was substantial. MRA image quality was adequate for RAS evaluations in all patients. ROC curves indicated that MRA is an adequate method for evaluating RAS. When screening for RAS, a 50% diameter reduction cut-off is better than 60%. RAS with 40-80% diameter reductions accounted for 65% of discrepancies. Conclusion: MRA is an adequate method for evaluating RAS limited mainly by poor detection rate for accessory renal arteries

  17. Transcatheter Arterial Chemoembolization Based on Hepatic Hemodynamics for Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Satoru Murata

    2013-01-01

    Full Text Available Hepatocellular carcinoma (HCC is the sixth most common cancer and the third leading cause of cancer-related deaths in the world. The Barcelona Clinic Liver Cancer (BCLC classification has recently emerged as the standard classification system for clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, and percutaneous ablation can improve survival in HCC patients diagnosed at an early stage and offer potential long-term curative effects. Patients with intermediate-stage HCC benefit from transcatheter arterial chemoembolization (TACE, and those diagnosed at an advanced stage receive sorafenib, a multikinase inhibitor, or conservative therapy. Most patients receive palliative or conservative therapy only, and approximately 50% of patients with HCC are candidates for systemic therapy. TACE is often recommended for advanced-stage HCC patients all over the world because these patients desire therapy that is more effective than systemic chemotherapy or conservative treatment. This paper aims to summarize both the published data and important ongoing studies for TACE and to discuss technical improvements in TACE for advanced-stage HCC.

  18. Altered agonist-activated 86Rb+ efflux from arteries in canine renal hypertension

    International Nuclear Information System (INIS)

    Cox, R.H.; Bagshaw, R.J.

    1989-01-01

    Basal rate constants for 86 Rb+ efflux from renal arteries of renal hypertensive dogs were lower than those of control animals whereas no differences were found for coronary arteries. Norepinephrine produced parallel increases in efflux rate constants for hypertensive and control renal arteries, but serotonin produced smaller responses in hypertensive compared to control coronary arteries

  19. A unique case of bifid left testicular artery having its anomalous high origin from renal artery

    OpenAIRE

    Ashwini P Aithal; Naveen Kumar; Swamy S Ravindra; Jyothsna Patil

    2016-01-01

    The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed...

  20. Interventional treatment of transplanted renal artery stenosis

    International Nuclear Information System (INIS)

    Zhang Zefu; Liang Huiming; Feng Gansheng; Zheng Chuansheng; Wu Hanpin; Zhou Guofeng

    2008-01-01

    Objective: To evaluate the treatment of transplanted renal artery stenosis (TRAS) by pereutaneous transluminal angioplasty (PTA)and stentplacement. Methods: The averange time from trans- plantation to the symptom occurrence of TRAS was 5.5 months (4-15 months)in 12 TRAS patients. All of them received the interventional therapy through femoral approach. Average BP, creatinine level and stenosis before and after the procedure were taken as the judgement standards. Results: PTA was performed with balloon (length 20-40 mm, diameter 5-7 mm)in 4 patients, stenting after PTA in 5, including 3 of direct stenting. Two cases (17%)occurred restenosis after PTA and restenting was undertaken. Three ases (25%)with restenosis after stentplacement were undergone PTA. One self-expandable stent and 9 balloon- dilatation stent were released in 10 eases. Stenosis significantly decreased from 65%-95% preoperatively to 15%-25% postoperatively, together with average BP decreased from 175/105 mmHg to 140/80 mmHg and creatinine level decreased from 475.5 μmol/L to 118.5 μmol/L. Among 12 cases included 4 healed, melioration (5), improvement (2), and inefficiency (1) during follow-up of 9 months (3-24 months). No complication occurred. Conclusion: The interventional therapy is effective and safe for TRAS with high rates of procedure success and efficacy. The proper selection of the adapted approach combined with PTA and stenting may effectively raise the long term efficacy for TRAS and success rate of the procedure. (authors)

  1. Hemodynamic properties and arterial structure in male rat offspring with fetal hypothyroidism.

    Science.gov (United States)

    Ghanbari, Mahboubeh; Bagheripuor, Fatemeh; Piryaei, Abbas; Zahediasl, Saleh; Noroozzadeh, Mahsa; Ghasemi, Asghar

    2016-10-01

    Thyroid hormones (THs) play a crucial role in the development of different systems during fetal life; fetal hypothyroidism (FH) is associated with reduced cardiac function and dimensions in neonates. The aim of this study is to determine whether TH deficiency during fetal life is associated with arterial structural and hemodynamic changes during adulthood. Hypothyroidism was induced by adding 0.025% 6-propyl-2-thiouracil in drinking water throughout pregnancy, while controls consumed only tap water. Hemodynamic parameters, cross-sectional area, intima-media thickness (IMT), and density of nuclei of smooth muscle cells and endothelial cells (ECs) in the aorta and mesenteric arteries were measured. Compared to controls, in the FH group, baseline systolic blood pressure (105.7 ± 3.1 vs. 87.9 ± 3.3 mm Hg, p < 0.01), diastolic blood pressure (64.4 ± 1.7 vs. 53.2 ± 2.1 mm Hg, p < 0.05), and mean arterial pressure (80.9 ± 2.1 vs. 67.1 ± 2.1 mm Hg, p < 0.01) were significantly lower. In addition, in the FH group, intensity and latency of response to phenylephrine were significantly lower and longer, respectively, as were the IMT and density of ECs in the aorta and superior mesenteric arteries. In conclusion, this study showed that TH deficiency during fetal life can have long-lasting functional and histological effects, which can compromise cardiovascular function during adulthood.

  2. Pulmonary arterial hypertension in congenital heart disease: Correlation of radiologic index with hemodynamic data

    International Nuclear Information System (INIS)

    Choi, Young Hi

    1984-01-01

    It is well known that pulmonary arterial hypertension in congenital heart disease is an important prognostic factor, as is pulmonary vascular resistance. So it is tempting to get certain radiologic index that could predict the presence and the degree of pulmonary arterial hypertension. A total of 152 cases of left to right shunt with pulmonary arterial hypertension and 50 cases of left to right shunt without pulmonary arterial hypertension is presented, in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between March 1981 and February 1983. Statistical analysis of plain radiography findings with the emphasis on the correction of radiologic index with the hemodynamic data. The results are as follows: 1. The incidence of pulmonary arterial hypertension is much less in arterial septal defect than other two disease groups of left to right shunt. 2. PA/T ratio correlates well with pulmonary arterial pressure (r=0.674), especially in mild pulmonary hypertension group. No correlation in moderate pulmonary hypertension group in significant level. 3. PA/T ratio is below 38 in total cases of normal control group and in 32 cases (21.0%) among 152 cases of pulmonary arterial hypertension group. 4. The average PA/T ratio in normal pressure group of left to right shunt is 35.3, which has no significant difference from that of normal control group. 5. The average CT ratio of pulmonary arterial hypertension group is 59.0, which is larger than 49.1 of normal control group. The CT ratio shows no correlation with the pulmonary arterial pressure in statistically significant level. 6. The higher the pulmonary arterial pressure, the larger the Rp/Rs value. The Rp/Rs in atrial septal defect is 0.193 in average, the lowest value in comparison with other two disease groups.

  3. Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy.

    Science.gov (United States)

    Lv, Nan; Yu, Ying; Xu, Jinyu; Karmonik, Christof; Liu, Jianmin; Huang, Qinghai

    2016-08-01

    OBJECT Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP. METHODS Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups. RESULTS The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms.

  4. Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review.

    Science.gov (United States)

    Ghista, Dhanjoo N; Kabinejadian, Foad

    2013-12-13

    In this paper, coronary arterial bypass grafting hemodynamics and anastomosis designs are reviewed. The paper specifically addresses the biomechanical factors for enhancement of the patency of coronary artery bypass grafts (CABGs). Stenosis of distal anastomosis, caused by thrombosis and intimal hyperplasia (IH), is the major cause of failure of CABGs. Strong correlations have been established between the hemodynamics and vessel wall biomechanical factors and the initiation and development of IH and thrombus formation. Accordingly, several investigations have been conducted and numerous anastomotic geometries and devices have been designed to better regulate the blood flow fields and distribution of hemodynamic parameters and biomechanical factors at the distal anastomosis, in order to enhance the patency of CABGs. Enhancement of longevity and patency rate of CABGs can eliminate the need for re-operation and can significantly lower morbidity, and thereby reduces medical costs for patients suffering from coronary stenosis. This invited review focuses on various endeavors made thus far to design a patency-enhancing optimized anastomotic configuration for the distal junction of CABGs.

  5. Thermal effect on heart rate and hemodynamics in vitelline arteries of stage 18 chicken embryos.

    Science.gov (United States)

    Lee, Jung Yeop; Lee, Sang Joon

    2010-12-01

    We investigated the thermal effects on heart rate, hemodynamics, and response of vitelline arteries of stage-18 chicken embryos. Heart rate was monitored by a high-speed imaging method, while hemodynamic quantities were evaluated using a particle image velocimetry (PIV) technique. Experiments were carried out at seven different temperatures (36-42 °C with 1 °C interval) after 1h of incubation to stabilize the heart rate. The heart rate increased in a linear manner (r = 0.992). Due to the increased cardiac output (or heart rate), the hemodynamic quantities such as mean velocity (U(mean)), velocity fluctuation (U(fluc)), and peak velocity (U(peak)) also increased with respect to the Womersley number (Ω) in the manner r = 0.599, 0.693, and 0.725, respectively. This indicates that the mechanical force exerting on the vessel walls increases. However, the active response (or regulation) of the vitelline arteries was not observed in this study. Copyright © 2010 Elsevier Ltd. All rights reserved.

  6. Renal contrast-enhanced MR angiography: timing errors and accurate depiction of renal artery origins.

    Science.gov (United States)

    Schmidt, Maria A; Morgan, Robert

    2008-10-01

    To investigate bolus timing artifacts that impair depiction of renal arteries at contrast material-enhanced magnetic resonance (MR) angiography and to determine the effect of contrast agent infusion rates on artifact generation. Renal contrast-enhanced MR angiography was simulated for a variety of infusion schemes, assuming both correct and incorrect timing between data acquisition and contrast agent injection. In addition, the ethics committee approved the retrospective evaluation of clinical breath-hold renal contrast-enhanced MR angiographic studies obtained with automated detection of contrast agent arrival. Twenty-two studies were evaluated for their ability to depict the origin of renal arteries in patent vessels and for any signs of timing errors. Simulations showed that a completely artifactual stenosis or an artifactual overestimation of an existing stenosis at the renal artery origin can be caused by timing errors of the order of 5 seconds in examinations performed with contrast agent infusion rates compatible with or higher than those of hand injections. Lower infusion rates make the studies more likely to accurately depict the origin of the renal arteries. In approximately one-third of all clinical examinations, different contrast agent uptake rates were detected on the left and right sides of the body, and thus allowed us to confirm that it is often impossible to optimize depiction of both renal arteries. In three renal arteries, a signal void was found at the origin in a patent vessel, and delayed contrast agent arrival was confirmed. Computer simulations and clinical examinations showed that timing errors impair the accurate depiction of renal artery origins. (c) RSNA, 2008.

  7. A unique case of bifid left testicular artery having its anomalous high origin from renal artery

    Directory of Open Access Journals (Sweden)

    Ashwini P Aithal

    2016-01-01

    Full Text Available The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed behind the left renal vein, passed between the left testicular vein and left ureter and at the lower pole of the left kidney, this bifid testicular artery joined to form a single testicular artery which thereafter presented a normal course. Anatomy of the testicular artery has been studied in detail because of its importance in testicular physiology, as well as its significance in testicular and renal surgery. This vascular variation shows a major significance in renal surgery, partial or total nephrectomy, and renal transplant. In addition, this anatomical variation enhances the importance of arteriography or the Doppler ultrasound examination of the renal hilum before surgeries.

  8. "The challenge facing renal artery revascularization: what have we not proven and why we must"?

    LENUS (Irish Health Repository)

    Hynes, B G

    2012-01-04

    Endovascular renal artery stent therapy for atherosclerotic renal artery stenosis (RAS) is associated with excellent acute technical success, low complication rates and acceptable long-term patency. However, the clinical benefits to patients of renal artery stenting remain uncertain. To facilitate debate regarding the treatment of RAS, we need to understand the epidemiology, basic physiology and clinical consequences of renal artery stenosis. We must attempt to determine which patients are likely to benefit from renal artery stenting, assess the nuances of the percutaneous procedure and review the current literature pertaining to renal artery stenting.

  9. Incidental finding of a precaval right renal artery on CT: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hae Seung; Kim, Hyun Cheol; Shin, Hyeong Cheol; Kim, Young Hwa; Nam, Deok Ho; Kim, Il Young; Kim, Hyung Hwan; Bae, Won Kyung [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)

    2005-07-15

    The right renal artery passing anterior to the inferior vena cava is a rare variant of the normal renal arterial anatomy, and identifying this anomaly is important for the planning of minimally invasive renal surgery. The presence of this precaval right renal artery was detected on the contrast-enhanced CT scan by identifying the right renal artery passing anterior to the inferior vena cava. We report here on a case of a precaval right renal artery as a main supplying artery, and this was incidentally found on CT.

  10. Incidental finding of a precaval right renal artery on CT: a case report

    International Nuclear Information System (INIS)

    Lee, Hae Seung; Kim, Hyun Cheol; Shin, Hyeong Cheol; Kim, Young Hwa; Nam, Deok Ho; Kim, Il Young; Kim, Hyung Hwan; Bae, Won Kyung

    2005-01-01

    The right renal artery passing anterior to the inferior vena cava is a rare variant of the normal renal arterial anatomy, and identifying this anomaly is important for the planning of minimally invasive renal surgery. The presence of this precaval right renal artery was detected on the contrast-enhanced CT scan by identifying the right renal artery passing anterior to the inferior vena cava. We report here on a case of a precaval right renal artery as a main supplying artery, and this was incidentally found on CT

  11. The effect of anatomic differences on the relationship between renal artery and diaphragmatic crus.

    Science.gov (United States)

    Esen, K; Tok, S; Balci, Yuksel; Apaydin, F D; Kara, E; Uzmansel, D

    2018-01-01

    The aim of this study is to investigate the effect of anatomic differences on the relationship between renal artery and diaphragmatic crus via the touch of two structures. The study included dynamic computed tomography (CT) scans of 308 patients performed mainly for characterisation of liver and renal masses. Anatomic differences including the thickness of the diaphragmatic crus, the localisation of renal artery ostium at the wall of aorta, the level of renal artery origin with respect to superior mesenteric artery were evaluated. Statistical relationships between renal artery-diaphragmatic crus contact and the anatomic differences were assessed. Thickness of the diaphragmatic crus at the level of renal artery origin exhibited a statistically significant relationship to renal artery-diaphragmatic crus contact at the left (p renal artery origin and renal artery- -diaphragmatic crus contact at the left (p renal artery ostium at the wall of aorta (right side, p = 0.436, left side, p = 0.681) did not demonstrate a relationship to renal artery-diaphragmatic crus contact. Thickness of the diaphragmatic crus and high renal artery origin with respect to superior mesenteric artery are crucial anatomic differences determining the relationship of renal artery and diaphragmatic crus. (Folia Morphol 2018; 77, 1: 22-28).

  12. Transcatheter arterial ethanol embolization for congenital renal arteriovenous malformations

    International Nuclear Information System (INIS)

    Wang Jingbing; Wang Han; An Xiao; Wang Linchuan; Gao Liqiang; Zhou Zhiguo; Zhang Guixiang

    2010-01-01

    Objective: To discuss the effect and safety of trans-microcatheter arterial embolization with ethanol for the treatment of congenital renal arteriovenous malformations. Methods: Clinical data of 11 patients with congenital renal arteriovenous malformations manifested mainly as gross hematuria were retrospectively analyzed. Selective renal angiography was performed in all 11 patients. After the diagnosis was confirmed, super-selective catheterization of the diseased arteries was carried out and the trans-microcatheter arterial embolization with ethanol was conducted. Results: A total of 12 procedures were completed in 11 patients. The ethanol dose used in one procedure was 5-25 ml. Successful embolization of the congenital renal arteriovenous malformations was obtained in all patients. The gross hematuria disappeared within 24-48 hours after the treatment. Lumbago at treated side, low fever, abdominal distension, nausea, vomiting, etc. occurred within one week and no other serious complications developed. During the follow-up period lasting for 4-96 months, no recurrence of hematuria was observed and the renal function remained normal. Conclusion: Transcatheter arterial ethanol embolization is an economic, safe and effective treatment for congenital renal arteriovenous malformations. (authors)

  13. Nursing experience in clinical endovascular treatment for renal artery aneurysms

    International Nuclear Information System (INIS)

    Dong Yanfen; Pan Xiaoxia; Luan Shaoliang; Wei Ren

    2012-01-01

    Objective: To discuss the standardized clinical nursing measures for patients receiving endovascular treatment of renal artery aneurysms. Methods: The clinical data of 9 patients with renal artery aneurysm, who were admitted to authors' hospital during the period from Jan. 2010 to Aug. 2011 and received endovascular treatment, were retrospectively analyzed. The related nursing points as well as the received endovascular. Results: A total of 9 cases with renal artery aneurysm were treated nursing measures were summarized. Results: A total of 9 cases with renal artery aneurysm were with interventional management, including embolization (n = 6), stent implantation (n = 2) and stent implantation together with coil embolization (n = 1). The mean hospitalization time was (10±2) days. Postoperative retention of urine was observed in one patient and postoperative retroperitoneal hemorrhage occurred in another patient. Neither nursing-related nor operation-related complications occurred. Conclusion: Standardized perioperative nursing care for patients with renal artery aneurysm can surely help enhance the patient's tolerance to the surgery, and effectively prevent the complications. (authors)

  14. Renal Extraction and Acute Effects of Glucagon-like peptide-1 on Central and Renal Hemodynamics in Healthy Men

    DEFF Research Database (Denmark)

    Asmar, Ali; Simonsen, Lene; Asmar, Meena

    2015-01-01

    of either GLP-1 (1.5 pmol kg-1 min-1) or saline, cardiac output was estimated non-invasively, and intra-arterial blood pressure and heart rate were measured continuously. Renal plasma flow, glomerular filtration rate, and uptake/release of hormones and ions were measured by Fick's Principle after...... catheterization of a renal vein. The subjects remained supine during the experiments. During GLP-1 infusion, the systolic blood pressure and arterial pulse pressure both increased by 5 ± 1 mm Hg (p=0.015 and p=0.002, respectively). Heart rate increased by 5 ± 1 bpm (p=0.005) and cardiac output increased by 18...... % (p=0.016). Renal plasma flow and glomerular filtration rate as well as clearance of sodium and lithium were not affected by GLP-1. However, plasma renin activity decreased (p=0.037), whereas plasma levels of atrial natriuretic peptide (ANP) were unaffected. Renal extraction of intact GLP-1 was 43% (p...

  15. Modeling of Kidney Hemodynamics: Probability-Based Topology of an Arterial Network

    DEFF Research Database (Denmark)

    Postnov, Dmitry D; Marsh, Donald J; Postnov, Dmitry E

    2016-01-01

    CT) data we develop an algorithm for generating the renal arterial network. We then introduce a mathematical model describing blood flow dynamics and nephron to nephron interaction in the network. The model includes an implementation of electrical signal propagation along a vascular wall. Simulation...

  16. Oxygenation and hemodynamics in left and right cerebral hemispheres during induction of veno-arterial extracorporeal membrane oxygenation.

    NARCIS (Netherlands)

    Heyst, A.F.J. van; Liem, D.; Hopman, J.C.W.; Staak, F.H.J.M. van der; Sengers, R.C.A.

    2004-01-01

    OBJECTIVE: Oxygenation and hemodynamics in the left and right cerebral hemispheres were measured during induction of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). STUDY DESIGN: Using near infrared spectrophotometry, effects of right common carotid artery (RCCA) and right internal

  17. Medial arcuate ligament: a new anatomic landmark facilitates the location of the renal artery in retroperitoneal laparoscopic renal surgery.

    Science.gov (United States)

    Cai, Wei; Li, Hong Zhao; Zhang, Xu; Song, Yong; Ma, Xin; Dong, Jun; Chen, Wenzheng; Chen, Guang-Fu; Xu, Yong; Lu, Jin Shan; Wang, Bao-Jun; Shi, Tao-Ping

    2013-01-01

    The purpose of this study was to introduce a new method for locating the renal artery during retroperitoneal laparoscopic renal surgery. The medial arcuate ligament (MAL) is a tendinous arch in the fascia under the diaphragm that arches across the psoas major muscle and is attached medially to the side of the first or the second lumbar vertebra. The renal artery arises at the level of the intervertebral disc between the L1 and L2 vertebrae. We evaluate the role of the MAL that serves as an anatomic landmark for locating the renal artery during retroperitoneal laparoscopic renal surgery. There is a reproducible consistent anatomic relationship between MAL and the renal artery in 210 cases of retroperitoneal laparoscopic renal surgery. Two main types of the MAL, the "narrow arch" and the "fascial band" types, can be observed. MAL can serve as an accurate and reproducible anatomic landmark for the identification of the renal artery during retroperitoneal laparoscopic renal surgery.

  18. Renal effects of dexmedetomidine during coronary artery bypass surgery: a randomized placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Scheinin Harry

    2011-05-01

    Full Text Available Abstract Background Dexmedetomidine, an alpha2-adrenoceptor agonist, has been evaluated as an adjunct to anesthesia and for the delivery of sedation and perioperative hemodynamic stability. It provokes dose-dependent and centrally-mediated sympatholysis. Coronary artery bypass grafting (CABG with extracorporeal circulation is a stressful procedure increasing sympathetic nervous system activity which could attenuate renal function due the interrelation of sympathetic nervous system, hemodynamics and renal function. We tested the hypothesis that dexmetomidine would improve kidney function in patients undergoing elective CABG during the first two postoperative days. Methods This was a double-blind, randomized, parallel-group study. Patients with normal renal function and scheduled for elective CABG were randomized to placebo or to infusion of dexmedetomidine to achieve a pseudo steady-state plasma concentration of 0.60 ng/ml. The infusion was started after anesthesia induction and continued until 4 h after surgery. The primary endpoint was creatinine clearance. Other variables included urinary creatinine and output, fractional sodium and potassium excretion, urinary potassium, sodium and glucose, serum and urinary osmolality and plasma catecholamine concentrations. The data were analyzed with repeated-measures ANOVA or Cochran-Mantel-Haenszel test. Results Sixty-six of 87 randomized patients were evaluable for analysis. No significant between-group differences were recorded for any indices of renal function except for a mean 74% increase in urinary output with dexmedetomidine in the first 4 h after insertion of a urinary catheter (p Conclusions Use of intravenous dexmedetomidine did not alter renal function in this cohort of relatively low-risk elective CABG patients but was associated with an increase in urinary output. This study was carried out in 1994-1997 and was thus not registered.

  19. GPER Mediates Functional Endothelial Aging in Renal Arteries.

    Science.gov (United States)

    Meyer, Matthias R; Rosemann, Thomas; Barton, Matthias; Prossnitz, Eric R

    2017-01-01

    Aging is associated with impaired renal artery function, which is partly characterized by arterial stiffening and a reduced vasodilatory capacity due to excessive generation of reactive oxygen species by NADPH oxidases (Nox). The abundance and activity of Nox depends on basal activity of the heptahelical transmembrane receptor GPER; however, whether GPER contributes to age-dependent functional changes in renal arteries is unknown. This study investigated the effect of aging and Nox activity on renal artery tone in wild-type and GPER-deficient (Gper-/-) mice (4 and 24 months old). In wild-type mice, aging markedly impaired endothelium-dependent, nitric oxide (NO)-mediated relaxations to acetylcholine, which were largely preserved in renal arteries of aged Gper-/- mice. The Nox inhibitor gp91ds-tat abolished this difference by greatly enhancing relaxations in wild-type mice, while having no effect in Gper-/- mice. Contractions to angiotensin II and phenylephrine in wild-type mice were partly sensitive to gp91ds-tat but unaffected by aging. Again, deletion of GPER abolished effects of Nox inhibition on contractile responses. In conclusion, basal activity of GPER is required for the age-dependent impairment of endothelium-dependent, NO-mediated relaxation in the renal artery. Restoration of relaxation by a Nox inhibitor in aged wild-type but not Gper-/- mice strongly supports a role for Nox-derived reactive oxygen species as the underlying cause. Pharmacological blockers of GPER signaling may thus be suitable to inhibit functional endothelial aging of renal arteries by reducing Nox-derived oxidative stress and, possibly, the associated age-dependent deterioration of kidney function. © 2017 S. Karger AG, Basel.

  20. Numerical analysis of the effect of turbulence transition on the hemodynamic parameters in human coronary arteries.

    Science.gov (United States)

    Mahalingam, Arun; Gawandalkar, Udhav Ulhas; Kini, Girish; Buradi, Abdulrajak; Araki, Tadashi; Ikeda, Nobutaka; Nicolaides, Andrew; Laird, John R; Saba, Luca; Suri, Jasjit S

    2016-06-01

    Local hemodynamics plays an important role in atherogenesis and the progression of coronary atherosclerosis disease (CAD). The primary biological effect due to blood turbulence is the change in wall shear stress (WSS) on the endothelial cell membrane, while the local oscillatory nature of the blood flow affects the physiological changes in the coronary artery. In coronary arteries, the blood flow Reynolds number ranges from few tens to several hundreds and hence it is generally assumed to be laminar while calculating the WSS calculations. However, the pulsatile blood flow through coronary arteries under stenotic condition could result in transition from laminar to turbulent flow condition. In the present work, the onset of turbulent transition during pulsatile flow through coronary arteries for varying degree of stenosis (i.e., 0%, 30%, 50% and 70%) is quantitatively analyzed by calculating the turbulent parameters distal to the stenosis. Also, the effect of turbulence transition on hemodynamic parameters such as WSS and oscillatory shear index (OSI) for varying degree of stenosis is quantified. The validated transitional shear stress transport (SST) k-ω model used in the present investigation is the best suited Reynolds averaged Navier-Stokes turbulence model to capture the turbulent transition. The arterial wall is assumed to be rigid and the dynamic curvature effect due to myocardial contraction on the blood flow has been neglected. Our observations shows that for stenosis 50% and above, the WSSavg, WSSmax and OSI calculated using turbulence model deviates from laminar by more than 10% and the flow disturbances seems to significantly increase only after 70% stenosis. Our model shows reliability and completely validated. Blood flow through stenosed coronary arteries seems to be turbulent in nature for area stenosis above 70% and the transition to turbulent flow begins from 50% stenosis.

  1. Metabolic and Hormonal Determinants of Glomerular Filtration Rate and Renal Hemodynamics in Severely Obese Individuals

    Directory of Open Access Journals (Sweden)

    Edoardo Vitolo

    2016-10-01

    Full Text Available Objective: Renal function is often compromised in severe obesity. A true measurement of glomerular filtration rate (GFR is unusual, and how estimation formulae (EstForm perform in such individuals is unclear. We characterized renal function and hemodynamics in severely obese individuals, assessing the reliability of EstForm. Methods: We measured GFR (mGFR by iohexol plasma clearance, renal plasma flow (RPF by 123I-ortho-iodo-hippurate, basal and stimulated vascular renal indices, endothelium-dependent and -independent vasodilation using flow-mediated dilation (FMD as well as metabolic and hormonal profile in morbid, otherwise healthy, obese subjects. Results: Compared with mGFR, the better performing EstForm was CKD-EPI (5.3 ml/min/1.73 m2 bias by Bland-Altman analysis. mGFR was directly related with RPF, total and incremental glucose AUC, and inversely with PTH and h8 cortisol. Patients with mGFR below the median shown significantly higher PTH and lower vitamin D3. Basal or dynamic renal resistive index, FMD, pulse wave velocity were not related with mGFR. In an adjusted regression model, renal diameter and plasma flow remained related with mGFR (R2 = 0.67, accounting for 15% and 21% of mGFR variance, respectively. Conclusions: CKD-EPI formula should be preferred in morbid obesity; glucose increments during oral glucose tolerance test correlate with hyperfiltration; RPF and diameter are independent determinants of mGFR; slightly high PTH values, frequent in obesity, might influence mGFR.

  2. Arterial embolization for treating post-transplanted renal failure

    International Nuclear Information System (INIS)

    Yang Xizhang; Yang Li; Chen Ziqian; Yang Yongyan

    2008-01-01

    Objective: To investigate the significance of renal arterial embolization nephrectomy for treating post-transplanted renal failure. Methods: 15 cases of post-transplanted renal failure received renal arterial embolization. The post-procedural efficacies were followed up for about 6 months to 4 years. Results: Among the 15 cases, 11 showed blood pressure decreasing to normal level, 3 with reduction of the drug dose for anti-hypertension and 1 of no response. In addition, 12 suffered from postprocedural anuria, and 3 with obvious hypourocrinia associated with significant decrease of proteinuia; 5 with positive lymphcytic population response antigen (PRA > 20%), but turning negative with 3 of them after 3 weeks. All the transplanted kidneys revealed different degrees of atrophy but 4 of them obtained chances of successful retransplantation 3- 6 months after the procedure, 3 of them with follow up of 1-3 years were being well. Conclusions: Renal arterial embolization is a safe, efficient measure for treating post-transplanted renal failure with obvious decrease of correlative clinical symptoms and providing conditions for renal retransplantation. (authors)

  3. Noninvasive method using multidetector CT for calculating the relative blood supply ratio of duplicated renal arteries in renal donors

    International Nuclear Information System (INIS)

    Kuwabara, Masatomo; Kim, Tonsok; Nakamura, Hironobu; Narumi, Yoshifumi; Takahashi, Satoru; Sato, Yoshinobu; Murakami, Takamichi

    2006-01-01

    The aim of this study was to evaluate the correlation between the renal artery cross-sectional area measured by multidetector computed tomography (MDCT) and the nephrogram area calculated by renal arteriography in potential living renal donors with duplicated renal arteries. Medical records of 18 patients with duplicated renal arteries who underwent both MDCT angiography and renal arteriography between 2001 and 2003 were retrospectively reviewed. All 20 kidneys were evaluated. Renal artery cross-sectional areas were measured using the workstation to which the CT data were transferred; the nephrogram areas on the digitized angiographic images were calculated using public domain software. Bland-Altman analysis was performed to compare the cross-sectional area ratio of the accessory arteries to the main renal arteries, with the ratios obtained from the nephrogram areas calculated from the arteriograms. The mean cross-sectional areas of the accessory and main renal arteries were 6.78 and 20.9 mm 2 , respectively. The ratio of the nephrogram areas calculated from the arteriograms ranged from 0.094 to 0.809. Bland-Altman analysis showed no significant difference. It is possible to predict the supply volume of accessory renal arteries by measuring the cross-sectional area of the accessory and main renal arteries in potential living renal donors. (author)

  4. RENAL DENERVATION IN RESISTANT ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2013-01-01

    Full Text Available A new method of non-drug treatment of resistant hypertension – renal denervation is considered. General information about resistant hypertension, method of renal denervation, the results of clinical studies on efficacy and safety, as well as own clinical case are presented.

  5. RENAL DENERVATION IN RESISTANT ARTERIAL HYPERTENSION

    OpenAIRE

    V. A. Sulimov; A. V. Rodionov; A. A. Svetankova; I. E. Deneka

    2015-01-01

    A new method of non-drug treatment of resistant hypertension – renal denervation is considered. General information about resistant hypertension, method of renal denervation, the results of clinical studies on efficacy and safety, as well as own clinical case are presented.

  6. RENAL DENERVATION IN RESISTANT ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2015-09-01

    Full Text Available A new method of non-drug treatment of resistant hypertension – renal denervation is considered. General information about resistant hypertension, method of renal denervation, the results of clinical studies on efficacy and safety, as well as own clinical case are presented.

  7. Sequential change of hemodynamic reserve in patients with major cerebral artery occlusion of severe stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Y.; Yamaguchi, T.; Tsuchiya, T. (National Cardiovascular Center, Osaka (Japan). Cerebrovascular Div.); Minematsu, K. (National Cardiovascular Center, Osaka (Japan). Research Inst.); Nishimura, T. (National Cardiovascular Inst., Osaka (Japan). Dept. of Diagnostic Radiology)

    1992-02-01

    To identify regional vasodilatory capacity and its sequential change, we evaluated prospectively a total of 78 acetazolamide tests in 51 patients with occlusion or greater than 75% stenosis of the carotid or middle cerebral arteries. The relative distribution of cerebral blood flow was determined by single photon emission computed tomography using N-isopropyl-p-({sup 123}I)-iodoamphetamine before and after intravenous injection of acetazolamide. Reduced vasodilatory capacity was demonstrated in 20 patients (38%), including 5 patients with hemodynamic transient ischemic attacks or infarction. Follow-up acetazolamide tests revealed asymptomatic progression of the arterial lesion (from stenosis to occlusion) in 1 patient and almost complete improvement of vasodilatory capacity in 5 patients, including 3 without surgical intervention. During an average follow-up period of 18.5 months, 4 patients died from cardiac causes or neoplasm; no neurovascular events occurred. Much larger numbers of patients with longer observation periods will be necessary to clarify the contribution of chronic hemodynamic failure to subsequent stroke. However, the present data indicate that the acetazolamide test is useful for assessing the course of high grade stenosis or occlusion of major cerebral arteries. (orig.).

  8. Atherosclerotic stenoses of renal arteries: Evaluation with CT

    International Nuclear Information System (INIS)

    Marteau, V.; Melki, J.P.; DuTemple, C.; Despres, E.; Taieb, A.

    1987-01-01

    Recent reports have shown that the long-term results of transluminal angioplasty (PTA) in renal arteries, performed to treat renovascular hypertension resulting from atherosclerotic disease, depended on the location, extent, and consistency of the obstructing lesions. Therefore, 30 patients shown with arteriography to have 40 atherosclerotic stenoses and five occlusions of the renal artery underwent CT for study of the walls of the aorta and renal arteries. CT easily demonstrates atherosclerotic lesions and seems better than arteriography when the lesions are ostial. It shows whether stenoses are calcified and also defines the lesions of the abdominal aorta, which is helpful when surgical bypass is considered. The paper presents the authors' preliminary findings. Long-term follow-up of these patients show if CT has a predictive value about PTA results

  9. Frequency and clinical predictors of coronary artery disease in chronic renal failure renal transplant candidates.

    Science.gov (United States)

    de Albuquerque Seixas, Emerson; Carmello, Beatriz Leone; Kojima, Christiane Akemi; Contti, Mariana Moraes; Modeli de Andrade, Luiz Gustavo; Maiello, José Roberto; Almeida, Fernando Antonio; Martin, Luis Cuadrado

    2015-05-01

    Cardiovascular diseases are major causes of mortality in chronic renal failure patients before and after renal transplantation. Among them, coronary disease presents a particular risk; however, risk predictors have been used to diagnose coronary heart disease. This study evaluated the frequency and importance of clinical predictors of coronary artery disease in chronic renal failure patients undergoing dialysis who were renal transplant candidates, and assessed a previously developed scoring system. Coronary angiographies conducted between March 2008 and April 2013 from 99 candidates for renal transplantation from two transplant centers in São Paulo state were analyzed for associations between significant coronary artery diseases (≥70% stenosis in one or more epicardial coronary arteries or ≥50% in the left main coronary artery) and clinical parameters. Univariate logistic regression analysis identified diabetes, angina, and/or previous infarction, clinical peripheral arterial disease and dyslipidemia as predictors of coronary artery disease. Multiple logistic regression analysis identified only diabetes and angina and/or previous infarction as independent predictors. The results corroborate previous studies demonstrating the importance of these factors when selecting patients for coronary angiography in clinical pretransplant evaluation.

  10. Does the renin-angiotensin system determine the renal and systemic hemodynamic response to sodium in patients with essential hypertension?

    NARCIS (Netherlands)

    vanPaassen, P; deZeeuw, D; Navis, G; deJong, PE

    Many patients with essential hypertension respond to a high dietary sodium intake with a rise in blood pressure. Experimental evidence suggests that the renal hemodynamic response to sodium determines, at least partially, this rise in blood pressure. Our aim was to clarify the role of the

  11. Effects of thrombin inhibition with melagatran on renal hemodynamics and function and liver integrity during early endotoxemia

    DEFF Research Database (Denmark)

    Nitescu, Nicoletta; Grimberg, Elisabeth; Ricksten, Sven-Erik

    2007-01-01

    Sepsis is associated with an activation of the coagulation system and multiorgan failure. The aim of the study was to examine the effects of selective thrombin inhibition with melagatran on renal hemodynamics and function, and liver integrity, during early endotoxemia. Endotoxemia was induced...

  12. RENAL AND SYSTEMIC HEMODYNAMIC-EFFECTS OF IBOPAMINE IN PATIENTS WITH MILD-TO-MODERATE CONGESTIVE-HEART-FAILURE

    NARCIS (Netherlands)

    LIEVERSE, AG; VANVELDHUISEN, DJ; SMIT, AJ; ZIJLSTRA, JG; MEIJER, S; REITSMA, WD; LIE, KI; GIRBES, ARJ

    To study the hemodynamic and renal effects of the orally (p.o.) active dopamine (DA) agonist ibopamine, we examined 10 patients with mild to moderate congestive heart failure (CHF), who were stable while treated with digoxin and diuretics. All patients were in New York Heart Association (NYHA)

  13. Renal Hemodynamic Effects of Serelaxin in Patients With Chronic Heart Failure A Randomized, Placebo-Controlled Study

    NARCIS (Netherlands)

    Voors, Adriaan A.; Dahlke, Marion; Meyer, Sven; Stepinska, Janina; Gottlieb, Stephen S.; Jones, Andrew; Zhang, Yiming; Laurent, Didier; Slart, Riemer H. J. A.; Navis, Gerjan J.

    2014-01-01

    Background-Serelaxin is a promising therapy for acute heart failure. The renal hemodynamic effects of serelaxin in patients with chronic heart failure are unknown. Methods and Results-In this double-blind, randomized, placebo-controlled, multicenter study, patients with New York Heart Association

  14. Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension.

    Science.gov (United States)

    Lauder, Lucas; Ewen, Sebastian; Tzafriri, Abraham Rami; Edelman, Elazer Reuven; Lüscher, Thomas Felix; Blankenstijn, Peter J; Dörr, Oliver; Schlaich, Markus; Sharif, Faisal; Voskuil, Michiel; Zeller, Thomas; Ukena, Christian; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

    2018-05-20

    With increasing attention to renovascular causes and targets for hypertension there arises a critical need for more detailed knowledge of renal arterial anatomy. However, a standardised nomenclature is lacking. The present study sought to develop a standardised nomenclature for renal anatomy considering the complexity and variation of the renal arterial tree and to assess the applicability of the nomenclature. One thousand hypertensive patients underwent invasive selective renal artery angiography in nine centres. Further, renovasography was performed in 249 healthy swine as a surrogate for normotensive anatomy. Anatomical parameters were assessed by quantitative vascular analysis. Patients' mean blood pressure was 168/90±26/17 mmHg. The right main renal artery was longer than the left (41±15 mm vs. 35±13 mm, prenal arteries and renal artery disease were documented in 22% and 9% of the patients, respectively. Other than exhibiting a longer left main renal artery in uncontrolled hypertensives (+2.7 mm, p=0.034) there was no anatomical difference between patients with controlled and uncontrolled hypertension. Main renal artery mean diameter was smaller in patients with impaired kidney function (GFR Renal arterial anatomy differs between sides but shows no difference between patients with and without blood pressure control. Impaired GFR was associated with small main renal artery diameter.

  15. Renal blood flow after selective injection of different dosages of diatrizoate into the renal artery

    International Nuclear Information System (INIS)

    Burgener, F.A.; Fischer, H.W.; Weber, D.A.

    1975-01-01

    The characteristic biphasic renal haemodynamic response to diatrizoate injected into the renal artery was shown in the dog with the 133-xenon washout technique. A brief increase in renal blood flow (RBF) during the first ten seconds is followed by a more prolonged period of diminuished RBF. A dose of 4 ml. diatrizoate 60% resulted in the maximum RBF increase of 43% after ten seconds, but even 1 ml. diatrizoate raised the RBF 24%. The initial vasodilator effect of diatrizoate compares well in its extent with the most potent renal vasodilators. (orig.) [de

  16. Contrast-enhanced magnetic resonance angiography: evaluation of renal arteries in living renal transplant donors

    International Nuclear Information System (INIS)

    Firat, Ali; Akin, Oguz; Muhtesem Agildere, Ahmet; Aytekin, Cuneyt; Haberal, Mehmet

    2004-01-01

    One of the most important steps before living-donor nephrectomy is assessment of renal vascular anatomy. The number, origins and lengths of the renal arteries and variations of renal veins must be determined in order to identify the kidney that is most suitable for transplantation. Digital subtraction angiography was long considered the standard procedure for this purpose, but this method has been replaced by non-invasive techniques. Contrast-enhanced magnetic resonance angiography is an accurate, safe and reliable method for imaging vasculature. This article reviews the technique and the clinical features of this method in the evaluation of living renal transplant donors

  17. Contrast-enhanced magnetic resonance angiography: evaluation of renal arteries in living renal transplant donors

    Energy Technology Data Exchange (ETDEWEB)

    Firat, Ali; Akin, Oguz; Muhtesem Agildere, Ahmet; Aytekin, Cuneyt; Haberal, Mehmet

    2004-10-01

    One of the most important steps before living-donor nephrectomy is assessment of renal vascular anatomy. The number, origins and lengths of the renal arteries and variations of renal veins must be determined in order to identify the kidney that is most suitable for transplantation. Digital subtraction angiography was long considered the standard procedure for this purpose, but this method has been replaced by non-invasive techniques. Contrast-enhanced magnetic resonance angiography is an accurate, safe and reliable method for imaging vasculature. This article reviews the technique and the clinical features of this method in the evaluation of living renal transplant donors.

  18. Rotational digital subtraction angiography of the renal arteries: technique and evaluation in the study of native and transplant renal arteries.

    Science.gov (United States)

    Seymour, H R; Matson, M B; Belli, A M; Morgan, R; Kyriou, J; Patel, U

    2001-02-01

    Rotational digital subtraction angiography (RDSA) allows multidirectional angiographic acquisitions with a single injection of contrast medium. The role of RDSA was evaluated in 60 patients referred over a 7-month period for diagnostic renal angiography and 12 patients referred for renal transplant studies. All angiograms were assessed for their diagnostic value, the presence of anomalies and the quantity of contrast medium used. The effective dose for native renal RDSA was determined. 41 (68.3%) native renal RDSA images and 8 (66.7%) transplant renal RDSA images were of diagnostic quality. Multiple renal arteries were identified in 9/41 (22%) native renal RDSA diagnostic images. The mean volume of contrast medium in the RDSA runs was 51.2 ml and 50 ml for native and transplant renal studies, respectively. The mean effective dose for 120 degrees native renal RDSA was 2.36 mSv, equivalent to 1 year's mean background radiation. Those RDSA images that were non-diagnostic allowed accurate prediction of the optimal angle for further static angiographic series, which is of great value in transplant renal vessels.

  19. Divergent effects of laughter and mental stress on arterial stiffness and central hemodynamics.

    Science.gov (United States)

    Vlachopoulos, Charalambos; Xaplanteris, Panagiotis; Alexopoulos, Nikolaos; Aznaouridis, Konstantinos; Vasiliadou, Carmen; Baou, Katerina; Stefanadi, Elli; Stefanadis, Christodoulos

    2009-05-01

    To investigate the effect of laughter and mental stress on arterial stiffness and central hemodynamics. Arterial stiffness and wave reflections are independent predictors of cardiovascular risk. Chronic psychological stress is an independent risk factor for cardiovascular events, whereas acute stress deteriorates vascular function. Eighteen healthy individuals were studied on three occasions, according to a randomized, single-blind, crossover, sham procedure-controlled design. The effects of viewing a 30-minute segment of two films inducing laughter or stress were assessed. Carotid-femoral pulse wave velocity was used as an index of arterial stiffness; augmentation index was used as a measure of wave reflections. Laughter decreased pulse wave velocity (by 0.30 m/sec, p = .01), and augmentation index (by 2.72%, p = .05). Conversely, stress increased pulse wave velocity (by 0.29 m/sec, p = .05) and augmentation index (by 5.1%, p = .005). Laughter decreased cortisol levels by 1.67 microg/dl (p = .02), soluble P-selectin by 26 ng/ml (p = .02) and marginally von Willebrand factor (by 2.4%, p = .07) and increased total oxidative status (by 61 micromol/L, p laughter) and negative (stress) behavioral interventions have divergent acute effects on arterial stiffness and wave reflections. These findings have important clinical implications extending the spectrum of lifestyle modifications that can ameliorate arterial function.

  20. Patient-specific 3D hemodynamics modelling of left coronary artery under hyperemic conditions.

    Science.gov (United States)

    Kamangar, Sarfaraz; Badruddin, Irfan Anjum; Govindaraju, Kalimuthu; Nik-Ghazali, N; Badarudin, A; Viswanathan, Girish N; Ahmed, N J Salman; Khan, T M Yunus

    2017-08-01

    The purpose of this study is to investigate the effect of various degrees of percentage stenosis on hemodynamic parameters during the hyperemic flow condition. 3D patient-specific coronary artery models were generated based on the CT scan data using MIMICS-18. Numerical simulation was performed for normal and stenosed coronary artery models of 70, 80 and 90% AS (area stenosis). Pressure, velocity, wall shear stress and fractional flow reserve (FFR) were measured and compared with the normal coronary artery model during the cardiac cycle. The results show that, as the percentage AS increase, the pressure drop increases as compared with the normal coronary artery model. Considerable elevation of velocity was observed as the percentage AS increases. The results also demonstrate a recirculation zone immediate after the stenosis which could lead to further progression of stenosis in the flow-disturbed area. Highest wall shear stress was observed for 90% AS as compared to other models that could result in the rupture of coronary artery. The FFR of 90% AS is found to be considerably low.

  1. Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms.

    Directory of Open Access Journals (Sweden)

    Nan Lv

    Full Text Available The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA aneurysms.In 129 PCoA aneurysms (85 ruptured, 44 unruptured, clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms.While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR, size ratio (SR, dome-to-neck ratio (DN, inflow angle (IA, normalized wall shear stress (NWSS and percentage of low wall shear stress area (LSA were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p < 0.001 and LSA (OR = 1.393, p = 0.041.Hemodynamics and morphology were related to rupture status of intracranial aneurysms. Higher IA and LSA were identified as discriminators for rupture status of PCoA aneurysms.

  2. Hemodynamic Based Coronary Artery Aneurysm Thrombosis Risk Stratification in Kawasaki Disease Patients

    Science.gov (United States)

    Grande Gutierrez, Noelia; Mathew, M.; McCrindle, B.; Kahn, A.; Burns, J.; Marsden, A.

    2017-11-01

    Coronary artery aneurysms (CAA) as a result of Kawasaki Disease (KD) put patients at risk for thrombosis and myocardial infarction. Current AHA guidelines recommend CAA diameter >8 mm or Z-score >10 as the criterion for initiating systemic anticoagulation. Our hypothesis is that hemodynamic data derived from computational blood flow simulations is a better predictor of thrombosis than aneurysm diameter alone. Patient-specific coronary models were constructed from CMRI for a cohort of 10 KD patients (5 confirmed thrombosis cases) and simulations with fluid structure interaction were performed using the stabilized finite element Navier-Stokes solver available in SimVascular. We used a closed-loop lumped parameter network (LPN) to model the heart and vascular boundary conditions coupled numerically to the flow solver. An automated parameter estimation method was used to match LPN values to clinical data for each patient. Hemodynamic data analysis resulted in low correlation between Wall Shear Stress (WSS)/ Particle Residence Time (PRT) and CAA diameter but demonstrates the positive correlation between hemodynamics and adverse patient outcomes. Our results suggest that quantifying WSS and PRT should enable identification of regions at higher risk of thrombosis. We propose a quantitative method to non-invasively assess the abnormal flow in CAA following KD that could potentially improve clinical decision-making regarding anticoagulation therapy.

  3. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation

    Energy Technology Data Exchange (ETDEWEB)

    VonAchen, Paige [Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN (United States); Hamann, Jason [Boston Scientific Corporation, Maple Grove, MN (United States); Houghland, Thomas; Lesser, John R.; Wang, Yale; Caye, David; Rosenthal, Kristi; Garberich, Ross F. [Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN (United States); Daniels, Mary [Vital Images/Toshiba, Minnetonka, MN (United States); Schwartz, Robert S., E-mail: rss@rsschwartz.com [Minneapolis Heart Institute and Foundation at Abbott Northwestern Hospital, Minneapolis, MN (United States)

    2016-10-15

    Objective: The aim of this study was to understand the role of accessory renal arteries in resistant hypertension, and to establish their role in nonresponse to radiofrequency renal denervation (RDN) procedures. Background: Prior studies suggest a role for accessory renal arteries in hypertensive syndromes, and recent clinical trials of renal denervation report that these anomalies are highly prevalent in resistant hypertension. This study evaluated the relationships among resistant hypertension, accessory renal arteries, and the response to radiofrequency (RF) renal denervation. Methods: Computed Tomography Angiography (CTA) and magnetic resonance imaging (MRI) scans from 58 patients with resistant hypertension undergoing RF renal denervation (RDN) were evaluated. Results were compared with CT scans in 57 healthy, normotensive subjects undergoing screening as possible renal transplant donors. All scans were carefully studied for accessory renal arteries, and were correlated with long term blood pressure reduction. Results: Accessory renal arteries were markedly more prevalent in the hypertensive patients than normotensive renal donors (59% vs 32% respectively, p = 0.004). RDN had an overall nonresponse rate of 29% (response rate 71%). Patients without accessory vessels had a borderline higher response rate to RDN than those with at least one accessory vessel (83% vs 62% respectively, p = 0.076) and a higher RDN response than patients with untreated accessory arteries (83% vs 55%; p = 0.040). For accessory renal arteries and nonresponse, the sensitivity was 76%, specificity 49%, with positive and negative predictive values 38% and 83% respectively. Conclusions: Accessory renal arteries were markedly over-represented in resistant hypertensives compared with healthy controls. While not all patients with accessory arteries were nonresponders, nonresponse was related to both the presence and non-treatment of accessory arteries. Addressing accessory renal arteries in

  4. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation

    International Nuclear Information System (INIS)

    VonAchen, Paige; Hamann, Jason; Houghland, Thomas; Lesser, John R.; Wang, Yale; Caye, David; Rosenthal, Kristi; Garberich, Ross F.; Daniels, Mary; Schwartz, Robert S.

    2016-01-01

    Objective: The aim of this study was to understand the role of accessory renal arteries in resistant hypertension, and to establish their role in nonresponse to radiofrequency renal denervation (RDN) procedures. Background: Prior studies suggest a role for accessory renal arteries in hypertensive syndromes, and recent clinical trials of renal denervation report that these anomalies are highly prevalent in resistant hypertension. This study evaluated the relationships among resistant hypertension, accessory renal arteries, and the response to radiofrequency (RF) renal denervation. Methods: Computed Tomography Angiography (CTA) and magnetic resonance imaging (MRI) scans from 58 patients with resistant hypertension undergoing RF renal denervation (RDN) were evaluated. Results were compared with CT scans in 57 healthy, normotensive subjects undergoing screening as possible renal transplant donors. All scans were carefully studied for accessory renal arteries, and were correlated with long term blood pressure reduction. Results: Accessory renal arteries were markedly more prevalent in the hypertensive patients than normotensive renal donors (59% vs 32% respectively, p = 0.004). RDN had an overall nonresponse rate of 29% (response rate 71%). Patients without accessory vessels had a borderline higher response rate to RDN than those with at least one accessory vessel (83% vs 62% respectively, p = 0.076) and a higher RDN response than patients with untreated accessory arteries (83% vs 55%; p = 0.040). For accessory renal arteries and nonresponse, the sensitivity was 76%, specificity 49%, with positive and negative predictive values 38% and 83% respectively. Conclusions: Accessory renal arteries were markedly over-represented in resistant hypertensives compared with healthy controls. While not all patients with accessory arteries were nonresponders, nonresponse was related to both the presence and non-treatment of accessory arteries. Addressing accessory renal arteries in

  5. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Docx, Martine K. [Koningin Paola Kinderziekenhuis, Department of Paediatrics, Chronic Diseases and Hypertension, Antwerp (Belgium); Vandenberghe, Philippe [Koningin Paola Kinderziekenhuis, Department of Paediatric Cardiology, Antwerp (Belgium); Maleux, Geert [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Gewillig, Marc [University Hospitals Leuven, Department of Paediatric Cardiology, Leuven (Belgium); Mertens, Luc [Hospital for Sick Children, Paediatric Cardiology, Toronto (Canada)

    2009-11-15

    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  6. Severe hypertension due to renal polar artery stenosis in an adolescent treated with coil embolization

    International Nuclear Information System (INIS)

    Docx, Martine K.; Vandenberghe, Philippe; Maleux, Geert; Gewillig, Marc; Mertens, Luc

    2009-01-01

    A 12-year-old boy presented with severe arterial hypertension due to a severe subsegmental renal artery stenosis. Treatment consisted of selective embolization of the stenosed polar artery, which resulted in near normalization of the arterial pressures. Renal artery stenosis should always be considered, even in young adolescents, as a cause for arterial hypertension. Only selective angiography was able to demonstrate the subsegmental artery stenosis in this patient. (orig.)

  7. Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography.

    Science.gov (United States)

    Ugurel, M S; Battal, B; Bozlar, U; Nural, M S; Tasar, M; Ors, F; Saglam, M; Karademir, I

    2010-08-01

    The purpose of our investigation was to determine the anatomical variations in the coeliac trunk-hepatic arterial system and the renal arteries in patients who underwent multidetector CT (MDCT) angiography of the abdominal aorta for various reasons. A total of 100 patients were analysed retrospectively. The coeliac trunk, hepatic arterial system and renal arteries were analysed individually and anatomical variations were recorded. Statistical analysis of the relationship between hepatocoeliac variations and renal artery variations was performed using a chi(2) test. There was a coeliac trunk trifurcation in 89% and bifurcation in 8% of the cases. Coeliac trunk was absent in 1%, a hepatosplenomesenteric trunk was seen in 1% and a splenomesenteric trunk was present in 1%. Hepatic artery variation was present in 48% of patients. Coeliac trunk and/or hepatic arterial variation was present in 23 (39.7%) of the 58 patients with normal renal arteries, and in 27 (64.3%) of the 42 patients with accessory renal arteries. There was a statistically significant correlation between renal artery variations and coeliac trunk-hepatic arterial system variations (p = 0.015). MDCT angiography permits a correct and detailed evaluation of hepatic and renal vascular anatomy. The prevalence of variations in the coeliac trunk and/or hepatic arteries is increased in people with accessory renal arteries. For that reason, when undertaking angiographic examinations directed towards any single organ, the possibility of variations in the vascular structure of other organs should be kept in mind.

  8. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation.

    Science.gov (United States)

    El-Sherbiny, M; Abou-Elela, A; Morsy, A; Salah, M; Foda, A

    2008-01-01

    This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning +/- MRA in some patients. In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.

  9. Low-profile stent system for treatment of atherosclerotic renal artery stenosis : The GREAT trial

    NARCIS (Netherlands)

    Sapoval, Marc; Zahringer, Markus; Pattynama, Peter; Rabbia, Claudio; Vignali, Claudio; Maleux, Geert; Boyer, Louis; Szczerbo-Trojanowska, Malgorzata; Jaschke, Werner; Hafsahl, Geir; Downes, Mark; Beregi, Jean Paul; Veeger, Nic; Talen, Aly

    PURPOSE: The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly

  10. Time-Series Interactions of Gene Expression, Vascular Growth and Hemodynamics during Early Embryonic Arterial Development.

    Directory of Open Access Journals (Sweden)

    Selda Goktas

    Full Text Available The role of hemodynamic forces within the embryo as biomechanical regulators for cardiovascular morphogenesis, growth, and remodeling is well supported through the experimental studies. Furthermore, clinical experience suggests that perturbed flow disrupts the normal vascular growth process as one etiology for congenital heart diseases (CHD and for fetal adaptation to CHD. However, the relationships between hemodynamics, gene expression and embryonic vascular growth are poorly defined due to the lack of concurrent, sequential in vivo data. In this study, a long-term, time-lapse optical coherence tomography (OCT imaging campaign was conducted to acquire simultaneous blood velocity, pulsatile micro-pressure and morphometric data for 3 consecutive early embryonic stages in the chick embryo. In conjunction with the in vivo growth and hemodynamics data, in vitro reverse transcription polymerase chain reaction (RT-PCR analysis was performed to track changes in transcript expression relevant to histogenesis and remodeling of the embryonic arterial wall. Our non-invasive extended OCT imaging technique for the microstructural data showed continuous vessel growth. OCT data coupled with the PIV technique revealed significant but intermitted increases in wall shear stress (WSS between first and second assigned stages and a noticeable decrease afterwards. Growth rate, however, did not vary significantly throughout the embryonic period. Among all the genes studied, only the MMP-2 and CASP-3 expression levels remained unchanged during the time course. Concurrent relationships were obtained among the transcriptional modulation of the genes, vascular growth and hemodynamics-related changes. Further studies are indicated to determine cause and effect relationships and reversibility between mechanical and molecular regulation of vasculogenesis.

  11. The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Ladefoged, S D

    1995-01-01

    The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurement of downstream renal artery resistance. Little information is available on their value in chronic renal failure and their correlation to parameters of renal function and haemodynamics. The aim...... was to compare PI and RI of renal arteries in healthy volunteers and in patients with hypertension and chronic renal failure, and furthermore to study the correlation of these indices to measurements of renal haemodynamics and function by standard methods in patients with renal failure and hypertension....

  12. Accessory renal arteries: Prevalence in resistant hypertension and an important role in nonresponse to radiofrequency renal denervation.

    Science.gov (United States)

    VonAchen, Paige; Hamann, Jason; Houghland, Thomas; Lesser, John R; Wang, Yale; Caye, David; Rosenthal, Kristi; Garberich, Ross F; Daniels, Mary; Schwartz, Robert S

    The aim of this study was to understand the role of accessory renal arteries in resistant hypertension, and to establish their role in nonresponse to radiofrequency renal denervation (RDN) procedures. Prior studies suggest a role for accessory renal arteries in hypertensive syndromes, and recent clinical trials of renal denervation report that these anomalies are highly prevalent in resistant hypertension. This study evaluated the relationships among resistant hypertension, accessory renal arteries, and the response to radiofrequency (RF) renal denervation. Computed Tomography Angiography (CTA) and magnetic resonance imaging (MRI) scans from 58 patients with resistant hypertension undergoing RF renal denervation (RDN) were evaluated. Results were compared with CT scans in 57 healthy, normotensive subjects undergoing screening as possible renal transplant donors. All scans were carefully studied for accessory renal arteries, and were correlated with long term blood pressure reduction. Accessory renal arteries were markedly more prevalent in the hypertensive patients than normotensive renal donors (59% vs 32% respectively, p=0.004). RDN had an overall nonresponse rate of 29% (response rate 71%). Patients without accessory vessels had a borderline higher response rate to RDN than those with at least one accessory vessel (83% vs 62% respectively, p=0.076) and a higher RDN response than patients with untreated accessory arteries (83% vs 55%; p=0.040). For accessory renal arteries and nonresponse, the sensitivity was 76%, specificity 49%, with positive and negative predictive values 38% and 83% respectively. Accessory renal arteries were markedly over-represented in resistant hypertensives compared with healthy controls. While not all patients with accessory arteries were nonresponders, nonresponse was related to both the presence and non-treatment of accessory arteries. Addressing accessory renal arteries in future clinical trials may improve RDN therapeutic efficacy

  13. Superselective renal artery embolization with lipiodol and absolute alcohol emulsion for renal tumor

    International Nuclear Information System (INIS)

    Yu Miao; Li Jiakai; Sun Minglu; Wang Huixian

    2008-01-01

    Objective: To evaluate the efficacy of the renal arterial embolization with lipidol and absolute alcohol emulsion in the treatment of renal tumors. Methods: The superselective renal arterial embolization by using coaxial-cathaterization with infusion of lipiodol and absolute alcohol (in proportion of 2 :1) emulsion was performed in twenty patients with malignant and benign kidney tumors. 4 weeks later, the renal arteriography was taken routinely and repeated embolization was performed in case of necessary; and follow up was carried out periodically. Results: The imaging findings showed thorough tumor necrosis and feeding vessel abruption in 18 cases after one session of treatment. The volume of tumors decreased more than a half in 13 patients (82.25%, 13/18) associated with a well-distributed lipidol inside the tumors. The second session of treatment was performed in other 2 patients and the clinical symptoms relieved obviously. Conclusions: The superselective renal artery embolization with lipidol and absolute alcohol emulsion can permanently embolize all tumor feeding arteries in capillary vessel level with maximum reservation of renal function, providing definitively efficacy and worthwhile to be recommended widely. (authors)

  14. Sympathetic nervous activity and renal and systemic hemodynamics in cirrhosis: plasma norepinephrine concentration, hepatic extraction, and renal release

    DEFF Research Database (Denmark)

    Ring-Larsen, H; Hesse, B; Henriksen, Jens Henrik Sahl

    1982-01-01

    as previously reported in healthy controls. The right kidney released NE into the systemic circulation. Renal venous plasma NE exceeded arterial concentration by 34% (p less than 0.01). It is concluded that sympathetic nervous activity is enhanced in patients with cirrhosis, and that this hyperactivity may...... in patients than controls (82 vs. 95 mm Hg, p less than 0.05) but did not change during the tilt. Plasma norepinephrine (NE) concentration was significantly higher in another eight patients with cirrhosis than in eight healthy controls (mean: 0.45 vs. 0.21 ng per ml in recumbency, p less than 0.02). Following...

  15. Acute renal haemodynamic and renin-angiotensin system responses to graded renal artery stenosis in the dog.

    Science.gov (United States)

    Anderson, W P; Johnston, C I; Korner, P I

    1979-01-01

    1. The acute renal haemodynamic and renin-angiotensin system responses to graded renal artery stenosis were studied in chronically instrumented, unanaesthetized dogs. 2. Stenosis was induced over 30 sec by inflation of a cuff around the renal artery to lower distal pressure to 60, 40 or 20 mmHg, with stenosis maintained for 1 hr. This resulted in an immediate fall in renal vascular resistance, but over the next 5--30 min both resistance and renal artery pressure were restored back towards prestenosis values. Only transient increases in systemic arterial blood pressure and plasma renin and angiotensin levels were seen with the two milder stenoses. Despite restoration of renal artery pressure, renal blood flow remained reduced at all grades of stenosis. 3. Pre-treatment with angiotensin I converting enzyme inhibitor or sarosine1, isoleucone8 angiotensin II greatly attenuated or abolished the restoration of renal artery pressure and renal vascular resistance after stenosis, and plasma renin and angiotensin II levels remained high. Renal dilatation was indefinitely maintained, but the normal restoration of resistance and pressure could be simulated by infusing angiotensin II into the renal artery. 4. The effective resistance to blood flow by the stenosis did not remain constant but varied with changes in the renal vascular resistance. PMID:219182

  16. Doppler Flow Wire Evaluation of Renal Blood Flow Reserve in Hypertensive Patients with Normal Renal Arteries

    International Nuclear Information System (INIS)

    Beregi, Jean-Paul; Mounier-Vehier, Claire; Devos, Patrick; Gautier, Corinne; Libersa, Christian; McFadden, Eugene P.; Carre, Alain

    2000-01-01

    Purpose: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension.Methods: We studied the reactivity of the renal microcirculation to papaverine, with intraarterial Doppler and quantitative arteriography, in 34 renal arteries of 19 hypertensive patients without significant renal artery stenosis. Isosorbide dinitrate was given to maximally dilate proximal renal arteries. APV (average peak blood flow velocity) was used as an index of renal blood flow.Results: Kidneys could be divided into two distinct subgroups based on their response to papaverine. An increase in APV of up to 55% occurred in 21 kidneys, an increase > 55% in 13 kidneys. Within each group the values were normally distributed. Both baseline APV and the effect of papaverine on mean velocity differed significantly between groups.Conclusion: There seems to be a subgroup of patients with essential hypertension that has an impaired reactivity to papaverine, consistent with a functional impairment of the renal microcirculation. Further studies are required to determine whether this abnormality contributes to or results from elevated blood pressure

  17. Interaction between alpha 2-adrenergic and angiotensin II systems in the control of glomerular hemodynamics as assessed by renal micropuncture in the rat

    Science.gov (United States)

    Thomson, S. C.; Gabbai, F. B.; Tucker, B. J.; Blantz, R. C.

    1992-01-01

    The hypothesis that renal alpha 2 adrenoceptors influence nephron filtration rate (SNGFR) via interaction with angiotensin II (AII) was tested by renal micropuncture. The physical determinants of SNGFR were assessed in adult male Munich Wistar rats 5-7 d after ipsilateral surgical renal denervation (DNX). DNX was performed to isolate inhibitory central and presynaptic alpha 2 adrenoceptors from end-organ receptors within the kidney. Two experimental protocols were employed: one to test whether prior AII receptor blockade with saralasin would alter the glomerular hemodynamic response to alpha 2 adrenoceptor stimulation with the selective agonist B-HT 933 under euvolemic conditions, and the other to test whether B-HT 933 would alter the response to exogenous AII under conditions of plasma volume expansion. In euvolemic rats, B-HT 933 caused SNGFR to decline as the result of a decrease in glomerular ultrafiltration coefficient (LpA), an effect that was blocked by saralasin. After plasma volume expansion, B-HT 933 showed no primary effect on LpA but heightened the response of arterial blood pressure, glomerular transcapillary pressure gradient, and LpA to AII. The parallel results of these converse experiments suggest a complementary interaction between renal alpha 2-adrenergic and AII systems in the control of LpA.

  18. Renal arterial aneurysm--an incidental finding at autopsy.

    Directory of Open Access Journals (Sweden)

    Vaideeswar P

    1998-01-01

    Full Text Available Herein we describe a rare case of saccular renal artery aneurysm seen as an incidental autopsy finding in an elderly, hypertensive female. The aneurysm was seen as a small exophytic mass with calcified wall and lumen occluded by recanalized thrombus.

  19. Impact of diabetes mellitus on outcome of renal artery stenting

    International Nuclear Information System (INIS)

    Song Li; Tong Xiaoqiang; Wang Jian; Yang Min; Lv Yongxing; Zou Yinghua

    2007-01-01

    Objective: To investigate the impact of diabetes mellitus on outcome of renal artery stenting. Methods: 85 consecutive cases of renal artery stenosis received renal angioplasty were retrospectively analyzed. 25 patients with related history were selected into diabetic group (DM), and 60 patients without diabetics into control group(NDM). Pre- and post- procedure serum creatinine and blood pressure between the 2 groups were collected and analyzed. Results: The average serum creatinine pre-intervention and post-intervention were(132.24 ± 33.71) μmol/L, (126.32 ± 29.65) μmol/L for DM group, and(125.02 ± 48.13) μmol/L, (118.31 ± 39.58) μmol/L for NDM group respectively with no significant statistical difference (P > 0.05). The blood pressure was controlled satisfactorily for both groups after the procedure, with statistical significance (P<0.05), but no difference between the two groups. Conclusions: The procedure with renal artery stenting is effective to maintain renal function and control hypertension, showing equal efficiency for both DM and NDM patients. (authors)

  20. Follow-up of renal and mesenteric artery revascularization with duplex ultrasonography

    Science.gov (United States)

    Taylor, David C.; Houston, Gordon T.M.; Anderson, Caroline; Jameson, Margot; Popatia, Shelley

    1996-01-01

    Objective To evaluate the long-term anatomic results of renal revascularization procedures using duplex ultrasonography. Design A case series. Setting A university-affiliated hospital. Patients Twenty-five patients who had undergone renal percutaneous transluminal angioplasty (PTA) (18 arteries), renal bypass (10 arteries) and mesenteric bypass (6 arteries). The mean follow-up was 22 months (range from 3 to 48 months) for those who underwent renal PTA, 23 months (range from 1.5 to 70 months) for those who underwent renal bypass and 34 months (range from 8 to 144 months) for those who underwent mesenteric bypass. Main Outcome Measures Patency rates for the three procedures as assessed by duplex ultrasonography. Results Duplex ultrasonography demonstrated patency without stenosis after renal and mesenteric artery revascularization in 14 arteries subjected to renal PTA, 9 arteries subjected to renal bypass and 6 arteries subjected to mesenteric bypass. Three arteries that had renal PTA had recurrent vessel stenosis and one had occlusion. One artery that had renal bypass showed occlusion. Conclusions Renal PTA, renal bypass and mesenteric bypass are durable procedures at 2 years of follow-up, and duplex ultrasonography is a valuable method for assessing the patency of arteries after renal and mesenteric revascularization. PMID:8599785

  1. Variations in Branching Pattern of Renal Artery in Kidney Donors Using CT Angiography.

    Science.gov (United States)

    Munnusamy, Kumaresan; Kasirajan, Sankaran Ponnusamy; Gurusamy, Karthikeyan; Raghunath, Gunapriya; Bolshetty, Shilpakala Leshappa; Chakrabarti, Sudakshina; Annadurai, Priyadarshini; Miyajan, Zareena Begum

    2016-03-01

    Each kidney is supplied by a single renal artery originating from abdominal aorta. Since there are lots of renal surgeries happening now-a-days, it becomes mandatory for the surgeons to understand the abnormality and variations in the renal vasculature. To study the variations in the branching pattern of renal artery for the presence of early division and accessory renal artery in Indian kidney donors using CT angiography. The CT angiogram images of 100 normal individuals willing for kidney donation were analysed for early divisions and occurrence of accessory renal artery. A 51% of kidney donors showed variation in the renal artery. Out of 51% variations 38 individuals had accessory renal artery and 13 individuals had early division of renal artery. The distribution of accessory renal artery was equal on both sides (13% on right and left) and 12% of individuals had accessory renal artery on both sides. Out of 13% earlier divisions, 5% was on right side, 7% was on left side and 1% was on both sides. This study concludes that 51% of kidney donors had renal artery variations. Hence, awareness of variations by evaluating the donors is a must before renal transplantation, urological procedures and angiographic interventions.

  2. Effects of hypercholesterolemia of renal hemodynamics: study in patients with nephrotic syndrome.

    Science.gov (United States)

    Fuiano, G; Esposito, C; Sepe, V; Colucci, G; Bovino, M; Rosa, M; Balletta, M; Bellinghieri, G; Conte, G; Cianciaruso, B; Dal Canton, A

    1996-01-01

    Experimental and clinical studies have demonstrated a positive relationship between hyperlipidemia and rate of progression of renal disease, suggesting that lipids can induce or aggravate glomerular injury mainly by interacting with mesangial cells. Nevertheless, recently has been demonstrated that increased cholesterol levels can also induce endothelial cell dysfunction. Thus, since endothelium is known to play a major role in modulating the vascular tone, we have tested the possibility that hypercholesterolemia impairs the renal hemodynamics in patients with active nephrotic syndrome and elevated serum cholesterol levels. In this single-blind, nonrandom study, 12 patients were treated with pravastatin (group T, treated, n = 12) and 8 with placebo (group C, controls, n = 8). The controls were studied after the pravastatin group had been completed. Before starting the treatment the patients underwent basal determinations including routine laboratory investigations and PAH and inulin clearances. The same determinations were repeated after 48 h, and 6 and 12 weeks from the beginning of the treatment. The study at 48 h was performed to see if pravastatin had a direct, cholesterol-independent effect on renal function. The following basal results were reported (mean +/- SEM; group T vs. group C): serum cholesterol (mmol/l) 9.7 +/- 0.4 vs. 9.1 +/- 0.3 (NS); proteinuria (g/24 h): 6.2 +/- 0.2 vs. 7.0 +/- 0.7 (NS); PAH clearance (ml/min): 353 +/- 21 vs. 385 +/- 31 (NS); inulin clearance (ml/min): 62.5 +/- 7.7 vs. 67 +/- 9.3 (NS). After 48 h, no changes were observed in both groups. Subsequently, in group T, the following percentage changes of basal levels were observed: serum cholesterol -21.4 +/- 3.2% at 6 weeks (p < 0.05) and -34.9 +/- 3.2% at 12 weeks (p < 0.01); inulin clearance +3 +/- 3.7% at 6 weeks (NS) and +9.3 +/- 2.9% at 12 weeks (p < 0.05); PAH clearance +7 +/- 3.1% at 6 weeks (p < 0.05) and +21.2 +/- 5.5% at 12 weeks (p < 0.01). By contrast, no significant

  3. Evaluation of renal artery and renal masses using enhanced dynamic MRI. Three-dimensional volumetric interpolated breath-hold examination

    International Nuclear Information System (INIS)

    Ishikawa, Aimi; Kakizaki, Dai; Ito, Naoki; Shindou, Hiroaki; Ozuki, Taizou; Abe, Kimihiko; Sasaki, Kazuyoshi; Katsuyama, Hiroaki

    2003-01-01

    The purpose of this study was to evaluate of three-dimensional volumetric interpolated breathhold examination (3D-VIBE) for imaging renal arteries in renal tumor surgery. Twenty four patients to evaluate renal arteries, and 30 patients for staging of renal tumors. For evaluation of renal arteries, the number of renal arteries and secondary branches, and the RA ratio (renal artery diameter per aorta diameter) were investigated. For tumor evaluation, we investigated T factor and presence and condition of tumor capsule, 3D-VIBE was performed with a MAGNETOM Symphony (Siemens, Erlangen, Germany). Before the dynamic study, we measured renal artery acquisition time with 1 ml of contrast material (Gd-DTPA) and 20 ml of physiological saline solution injected into a hand vein at a rate of 3 ml/sec using an automatic injector. The first phase was set for arrival of the Gd-DTPA at the renal artery, the 2nd for 40 sec after the 1st phase, and the 3rd 180 sec after injection. Then we started scanning with 19 ml of Gd-DTPA and 20 ml of physiological saline solution. Maximum intensity projection (MIP) and multiplanar reconstruction (MFR) were reconstructed by the image data set. All renal arteries were correctly counted In one case, a branch of the superior mesenteric artery (SMA) was mistaken for a renal artery, but correctly identified using a stereo view. The rate of depiction of secondary branches was 86% compared with RA ratio which was significantly smaller than on aortic angiography (p<0.05). The findings for 5 tumors were confirmed by CT, but differed pathologically. We believe 3D-VIBE is useful dynamic CT for evaluation of renal arteries and preoperative classification of renal tumors. (author)

  4. Echobiometrics kidney and renal artery triplex doppler of canine fetuses

    Directory of Open Access Journals (Sweden)

    M.A.R. Feliciano

    2014-04-01

    Full Text Available The aim of this study was to assess the sogographic parameters and biometry of canine fetal kidneys using the B mode, and to determinate the vascular index of the fetal renal arteries using the Doppler Triplex. Twenty four Shi-tzu and Pug, weighting between 4 and 10kg, aging between 4 and 6 years old were evaluated. The B mode, the fetal renal echobiometry and regularity of the renal surface, echotexture and cortex:medular ratio were evaluated during the 5th, 6th, 7th and 8th weeks of pregnancy. At the same time point of the B mode evaluation, the Doppler Triplex was carried out to assess the sistolic peak velocity (SPV, end diastolic velocity (EDV, vascular resistive (RI and pulsatility index (PI. B mode revealed no fetal renal abnormalities and echobiometry showed important measurements during fetal development (P0.05. B mode and Doppler Triplex were important tools for the assessment of fetal renal development, using echobiometry and renal arterial index in canie fetuses.

  5. Hilar Renal Artery Aneurysm - Ex-vivo Reconstruction and Autotransplantation.

    Science.gov (United States)

    Pinto Sousa, Pedro; Veiga, Carlos; Matos, Arlindo; Sá Pinto, Pedro; Almeida, Rui

    2017-01-01

    Renal artery aneurysm (RAA) is a rare clinical entity with an estimated prevalence of 0.15% to 0.1%in the general population. The majority of patients present asymptomatically and the diagnosis is made incidentally during a hypertension study test, and more rarely, fortuitously after backache. Indications to treat have been subject of intense debate, nevertheless there seems to be some consensus that RAAs greater than 2 cm in diameter, expanding RAA, with thrombus or in pregnant women should be treated. Treatment options vary between surgical or endovascular approach. The complex (hilar) RAA constitute a subset of RAA that present a therapeutic dilemma because of their anatomic location and may require extracorporeal arterial reconstruction and auto-transplantation. We describe a 71-year-old woman with a personal history of hypertension for more than twenty years but normal renal function. Following the study for an abdominal discomfort a complex RAA was incidentally diagnosed. Computed tomographic angiography with three-dimensional reconstruction revealed a 13mm, saccular aneurysm located at the right renal hilum. We performed hand-assisted laparoscopic nephrectomy with ex vivo repair of the RAA. The aneurysm was resected and a polar renal artery was implanted over the resected area with a latero-terminal anastomosis. Complementarily, the renal vein was augmented with a spiral great saphenous vein graft and finally the kidney was implanted into the right iliac fossa. The intervention and postoperative course were uneventful and the patient submitted to ultrasound evaluation on the day after procedure. It revealed normal renal perfusion with normal flow indices. In the last follow-up realized, two months after surgery the patient was alive with a well-functioning auto-transplant. RAA may be nowadays more frequently diagnosed due to the increasing use of imaging techniques. While renal artery trunk aneurysms are most often treated using an endovascular procedure it

  6. Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup [Dongguk University College of Medicine, Goyang (Korea, Republic of); Hwang, Jae Cheol [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2007-08-15

    Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization.

  7. Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

    International Nuclear Information System (INIS)

    Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup; Hwang, Jae Cheol

    2007-01-01

    Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization

  8. Balloon expandable intraluminal grafting of normal and abnormal renal arteries: Experimental study

    International Nuclear Information System (INIS)

    Palmaz, J.C.; Hayashi, H.; Schatz, R.; Hunter, G.; Tio, F.O.; Garcia, O.

    1986-01-01

    Balloon expandable intraluminal grafts were placed in renal arteries of eight adult dogs and 11 minipigs. The renal arteries were normal in the dogs before graft placement. Two grafts were placed in primary division branches and the rest in the main renal artery. Experimental renal artery stenosis was created in the minipigs by subocclusive ligature of the renal artery with absorbable suture material. Six months later significant renal artery stenoses developed in six pigs and were corrected by graft placement. In the remaining pigs grafts were placed in the opposite normal renal artery because the stenosis caused a small, shrunken kidney in two, and severe spasm or anatomic variations prevented graft placement in three. All grafts remained patent on angiographic and pathologic examinations to a maximum follow-up to 24 weeks

  9. Characterization of hemodynamics and oxygenation in the renal cortex of rats

    Science.gov (United States)

    Grosenick, Dirk; Wabnitz, Heidrun; Macdonald, Rainer; Niendorf, Thoralf; Cantow, Kathleen; Flemming, Bert; Arakelyan, Karen; Seeliger, Erdmann

    2015-03-01

    We have performed a pre-clinical study on 13 rats to investigate the potential of near-infrared spectroscopy for quantification of hemoglobin concentration and oxygen saturation of hemoglobin in the renal cortex of small animals. These measurements were combined with laser-Doppler fluxmetry and a fluorescence quenching technique for quantification of tissue oxygen tension. Hemoglobin concentration and oxygen saturation were determined from experimental data by a Monte Carlo model. The methods were applied to investigate and compare temporal changes during several types of interventions such as arterial and venous occlusions, as well as hyperoxia, hypoxia and hypercapnia induced by different mixtures of the inspired gas.

  10. Comparison of clearance and arteriovenous extraction techniques for measurements of renal hemodynamic functions

    International Nuclear Information System (INIS)

    Katzberg, R.W.; Pabico, R.C.; Morris, T.W.; Hayakawa, K.; McKenna, B.A.; Ventura, J.A.; Fischer, H.W.

    1986-01-01

    No previous studies have directly compared timed urine collections (UV/P) vs. arteriovenous (A-V) extraction methods for determination of renal function in whole kidney preparations. We examined different markers and techniques for assessing renal plasma flow (RPF), filtration fraction (FF), and glomerular filtration rate (GFR) in both steady-state and rapidly changing conditions following 2 ml/kg bolus intravenous injections of either Renografin 76% (meglumine/sodium diatrizoate-76%) or hypertonic mannitol 25%. During steady-state conditions, excellent correlations were obtained when comparing markers and techniques. Thus, timed urinary clearances of inulin vs. 99m-technetium DTPA (Tc) had a correlation coefficient (R) of .96 (P less than .01; n = 16), and the A-V extraction technique of inulin vs. Tc as determinants of GFR showed a correlation of R = .98 (P less than .01; n = 15). The timed urinary clearance of inulin vs. the A-V extraction of inulin for glomerular filtration gave a correlation of R = .93 (P less than .01; n = 15). The clearance of para-aminohippurate (PAH) divided by the extraction of PAH vs. flow determinations using the electromagnetic flowmeter gave a correlation of R = .92 (P less than .01; n = 16). The anticipated decrease in GFR following contrast medium and hypertonic mannitol was observed using the A-V extraction technique, whereas an artifactual, exaggerated increase in GFR was observed using the timed urine collection technique. Similarly, we noted an exaggerated increase in RPF using CPAH/EPAH as the methodology. We conclude that rapid changes in renal hemodynamics may be measured accurately using the A-V extraction technique but not with clearance techniques requiring timed urine collections

  11. Renal dynamic scintigraphy with captropil in systemic arterial hypertension diagnosis

    International Nuclear Information System (INIS)

    Cervo, Marco Antonio Cadorna; Amarante Junior, Jose Luiz de Medeiros; Souza, Ricardo Alberto Manhaes; Evangelista, Maria Gardenia

    1995-01-01

    Forty one patients, 15 male and 16 female presenting systemic arterial hypertension were submitted to Basal RDC and after being simulated by Captopril; the radiotracer used was 99 mTc-DTPA (dietileno triamino pentacetic acid-99 Tc-technetium). From the 41 patients studied, 13 had the GFR (Glomerular filtration rate) Captopril when compared to Basal RDC radioactive, 11 of them were confirmed as having vascular renal disease by Renal Artiography and two of them were false (one case renal litiase and the other chronic pyelonephritis). Two more false negative cases have occurred in the RDC and three patients refused to be submitted to a Renal Arteriography. In the cases which the Total Glomerular Filtration Rate was reduced, there was an agreement of 89,5% between the RDC and the Renal Arteriography. No alterations have been observed in the Renal Arteriography on the remaining 23 patients and in the RDC after Captopril there was normal increase in the Glomerular Filtration Rate when compared to the Basal RDC. The method has showed sensitivity of 84% and specificity of 92%. We can conclude that the RDC with Captopril test is not an invasive method, it has good sensitivity and specificity and it can be indicated as a beginning test to select patients when you intend to detect vascular renal disease; nevertheless the RDC will never be used as a final test of vascular lesion. (author)

  12. Successful angioplasty of tripolar renal arteries in a single setting: a case report.

    Science.gov (United States)

    Sharma, Gyarsi Lal; Morice, Marie-Claude; Catineau, Patrick

    2002-08-01

    Renal artery stenosis (RAS) is one of the important causes of correctable hypertension. There are various modes of therapy for RAS, including percutaneous transluminal renal angioplasty (PTRA) and surgery. PTRA has emerged as the treatment of choice in cases of renal artery stenosis. PTRA combined with stenting is associated with good immediate and long-term results. This case report describes successful angioplasty of bilateral multiple renal arteries in a single setting with good immediate and follow-up results.

  13. Doppler examination of the periorbital arteries adds valuable hemodynamic information in carotid artery disease

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T; Steenberg, H J

    1987-01-01

    The periorbital flow direction and internal carotid artery (ICA) angiogram were compared to the ICA pressure gradient across the stenosis and the distal ICA pressure in 51 patients subjected to carotid endarterectomy. All 17 patients with inverted periorbital flow had stenoses exceeding 50%. The ...... collaterals and, Patients with 50% stenosis or more and insufficient collaterals....

  14. Low-energy shock wave preconditioning reduces renal ischemic reperfusion injury caused by renal artery occlusion.

    Science.gov (United States)

    Xue, Yuquan; Xu, Zhibin; Chen, Haiwen; Gan, Weimin; Chong, Tie

    2017-07-01

    To evaluate whether low energy shock wave preconditioning could reduce renal ischemic reperfusion injury caused by renal artery occlusion. The right kidneys of 64 male Sprague Dawley rats were removed to establish an isolated kidney model. The rats were then divided into four treatment groups: Group 1 was the sham treatment group; Group 2, received only low-energy (12 kv, 1 Hz, 200 times) shock wave preconditioning; Group 3 received the same low-energy shock wave preconditioning as Group 2, and then the left renal artery was occluded for 45 minutes; and Group 4 had the left renal artery occluded for 45 minutes. At 24 hours and one-week time points after reperfusion, serum inducible nitric oxide synthase (iNOS), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), creatinine (Cr), and cystatin C (Cys C) levels were measured, malondialdehyde (MDA) in kidney tissue was detected, and changes in nephric morphology were evaluated by light and electron microscopy. Twenty-four hours after reperfusion, serum iNOS, NGAL, Cr, Cys C, and MDA levels in Group 3 were significantly lower than those in Group 4; light and electron microscopy showed that the renal tissue injury in Group 3 was significantly lighter than that in Group 4. One week after reperfusion, serum NGAL, KIM-1, and Cys C levels in Group 3 were significantly lower than those in Group 4. Low-energy shock wave preconditioning can reduce renal ischemic reperfusion injury caused by renal artery occlusion in an isolated kidney rat model.

  15. Morphological and Hemodynamic Discriminators for Rupture Status in Posterior Communicating Artery Aneurysms.

    Science.gov (United States)

    Lv, Nan; Wang, Chi; Karmonik, Christof; Fang, Yibin; Xu, Jinyu; Yu, Ying; Cao, Wei; Liu, Jianmin; Huang, Qinghai

    2016-01-01

    The conflicting findings of previous morphological and hemodynamic studies on intracranial aneurysm rupture may be caused by the relatively small sample sizes and the variation in location of the patient-specific aneurysm models. We aimed to determine the discriminators for aneurysm rupture status by focusing on only posterior communicating artery (PCoA) aneurysms. In 129 PCoA aneurysms (85 ruptured, 44 unruptured), clinical, morphological and hemodynamic characteristics were compared between the ruptured and unruptured cases. Multivariate logistic regression analysis was performed to determine the discriminators for rupture status of PCoA aneurysms. While univariate analyses showed that the size of aneurysm dome, aspect ratio (AR), size ratio (SR), dome-to-neck ratio (DN), inflow angle (IA), normalized wall shear stress (NWSS) and percentage of low wall shear stress area (LSA) were significantly associated with PCoA aneurysm rupture status. With multivariate analyses, significance was only retained for higher IA (OR = 1.539, p PCoA aneurysms.

  16. Clinical, morphological, and hemodynamic independent characteristic factors for rupture of posterior communicating artery aneurysms.

    Science.gov (United States)

    Zhang, Ying; Jing, Linkai; Liu, Jian; Li, Chuanhui; Fan, Jixing; Wang, Shengzhang; Li, Haiyun; Yang, Xinjian

    2016-08-01

    To identify clinical, morphological, and hemodynamic independent characteristic factors that discriminate posterior communicating artery (PCoA) aneurysm rupture status. 173 patients with single PCoA aneurysms (108 ruptured, 65 unruptured) between January 2012 and June 2014 were retrospectively collected. Patient-specific models based on their three-dimensional digital subtraction angiography images were constructed and analyzed by a computational fluid dynamic method. All variables were analyzed by univariate analysis and multivariate logistic regression analysis. Two clinical factors (younger age and atherosclerosis), three morphological factors (higher aspect ratio, bifurcation type, and irregular shape), and six hemodynamic factors (lower mean and minimum wall shear stress, higher oscillatory shear index, a greater portion of area under low wall shear stress, unstable and complex flow pattern) were significantly associated with PCoA aneurysm rupture. Independent factors characterizing the rupture status were identified as age (OR 0.956, p=0.015), irregular shape (OR 6.709, pPCoA aneurysm rupture were younger age, irregular shape, and low minimum wall shear stress. This may be useful for guiding risk assessments and subsequent treatment decisions for PCoA aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Nurses' attitudinal and normative beliefs concerning hemodynamic assessment by pulmonary artery catheterization.

    Science.gov (United States)

    Pinto, Cristiano José Mendes; Colombo, Roberta Cunha Rodrigues; Gallani, Maria Cecília Bueno Jayme

    2006-01-01

    The objective of this study was to identify, by using the Theory of Reasoned Action/Theory of Planned Behavior, the attitude and normative beliefs that influence the behavioral intention of the nurse to perform a hemodynamic assessment using the pulmonary artery catheterization. Data were collected through semi-structured interviews involving 23 nurses from three hospitals in the city of Campinas, São Paulo. The data were analyzed according to a qualitative methodology. Among the Attitude Beliefs, affective beliefs and those related to the advantages and disadvantages of performing the behavior stand out. Among the Normative Beliefs social referents were identified for the behavior, as well as the behavior-stimulating factors and the factors that discourage the performance of the behavior.

  18. Positron emission tomographic measurement of acute hemodynamic changes in primate middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Tenjin, Hiroshi; Ueda, Satoshi; Mizukawa, Norihiko [Kyoto Prefectural Univ. of Medicine (Japan); and others

    1992-10-01

    Specific hemodynamic changes in acute ischemia were investigated using a middle cerebral artery occlusion primate model and positron emission tomography. The cerebral blood flow (CBF), cerebral blood volume, oxygen extraction fraction (OEF), and cerebral metabolic rate for oxygen were measured 1, 3, and 9 hours after occlusion. OEF showed an increase in ischemic areas, and especially where CBF was below 18 ml/100 gm/min 1 hour after occlusion the OEF increased significantly (0.69[+-]0.20, p<0.05). Nine hours after occlusion, the OEF values were lower compared to those 1 and 3 hours after occlusion. Areas where CBF ranged from 18 to 31 ml/100 gm/min showed an increase in OEF at all times (p<0.05). Clearly, OEF changes remarkably in the acute stage. (author).

  19. Influence of the measurement location on the resistance index in the umbilical arteries: a hemodynamic approach.

    Science.gov (United States)

    Vieyres, P; Durand, A; Patat, F; Descamps, P; Gregoire, J M; Pourcelot, D; Pourcelot, L

    1991-12-01

    A computer model was used to study the primary factors generating the reduction in resistance index, (S-D)/S, values observed by ultrasonic Doppler measurements in the umbilical artery, from the fetal insertion to the placental insertion (S represents the amplitude of the systolic peak and D the amplitude of the diastolic peak). This hemodynamic approach shows that the placental resistance is the primary factor, the viscosity and the cord length playing secondary roles. Clinically, the position of the measurement along the cord is an important factor. To increase the sensitivity of the index, the Doppler measurement must be performed near the fetal insertion, whereas a measurement near the placental insertion will make the Doppler examination more specific.

  20. The postprocessing techniques in renal artery reconstructions and clinical application with multidetector spiral CT angiography

    International Nuclear Information System (INIS)

    Yu Yuanxin; Liang Changhong; Zhang Zhonglin; Xie Shufei; Liu Yubao; Tang Xiangzhou

    2005-01-01

    Objective: To investigate the value and predominance for imaging postprocessing techniques of renal artery variation and lesions by multidetector spiral CT angiography. Methods: 51 patients with renal artery disease including 12 artery variation, 27 artery stenosis, 3 renal anenrysm, 3 thrombosis of renal artery and 3 dissecting aneurysm of renal artery by SSD, MIP and CPR were enrolled. The effectiveness of these imaging postprocessing methods was compared, 29 of them were confirmed by DSA and 3 by operation, others were checked by MRA and follow up. Results: All abnormalities and diseases were cleariy displayed. The specificity and sensitivity were 100% respectively. In the all imaging postprocessing techniques, MPR can clearly display the calcification of the arteries, stenosis, embolism, aneurysm but do not display the anatomy satisfactorily. MIP can not only clearly display the anatomy but display the different configurations. VR can display the artery figures but can not display the information of lumen of blood vessels. SSD can display the complex vessel anatomy but it was influenced by its threshold selection. CPR can spread and display directly the tortuous renal artery and measure the section area of stenosis. Conclusions: MSCTA is helpful to accurately display the renal artery variation and lesions. Both MIP and VR are the best choice to illustrate the renal artery abnormalities. And MPR and SSD are assistant in the diagnosis of' renal artery lesions. (authors)

  1. Study on the correlation of serum lipid metabolism and central retinal artery hemodynamics with diabetic retinopathy

    Institute of Scientific and Technical Information of China (English)

    Ran-Yang Guo

    2016-01-01

    Objective:To explore the correlation of serum lipid metabolism and central retinal artery (CRA) hemodynamics with diabetic retinopathy (DR).Methods:A total of 120 patients with type 2 diabetes who were admitted in our hospital from May, 2015 to May, 2016 were included in the study and divided into NDR group (non-diabetic retinopathy), NPR group (non-proliferative retinopathy), and PR group (proliferative retinopathy) with 40 cases in each group according to DR clinical staging. Moreover, 50 healthy individuals who came for physical examinations were served as the control group. The full automatic biochemical analyzer was used to detect the levels of TG, TC, LDL-C, and HDL-C. The color Doppler flow imaging (CDFI) was used to detect EDV, PSV, RI, and PI of CRA and OA.Results:The levels of TG, TC, and LDL-C in NDG, NPR, and PR groups were gradually increased with the aggravation of retinopathy, HDL-C was reduced, the comparison among the three groups was statistically significant, and the comparison with the control group was statistically significant. EDV, PSV, and PI of CRA and OA in NDG, NPR, and PR groups were gradually increased with the aggravation of retinopathy, RI was reduced, the comparison among the three groups was statistically significant, and the comparison with the control group was statistically significant. Conclusions: The lipid metabolism disorder can promote the occurrence and development of DR. The change of CRA and OA hemodynamics is an important pathological basis for developing DR. Clinical detection of serum lipid level and monitoring of the changes of fundus artery hemocynamic parameters are of great significance in early detecting DR.

  2. Renal angioplasty for atherosclerotic renal artery stenosis: Cardiologist′s perspective

    Directory of Open Access Journals (Sweden)

    A S Gulati

    2013-01-01

    Full Text Available Atherosclerotic renal artery stenosis (ARAS is frequently associated with concomitant coronary and peripheral arterial disease with a significant impact on cardiovascular morbidity and mortality. Renal angioplasty of ARAS is more challenging because of increased incidence of technical failures, complications, and restenosis; while there is barely perceptible control of hypertension and only marginal improvement in renal function. This is because most of the patient population in recent randomized trials had unmanifested or clinically silent renovascular disease. Manifestations of RAS should be looked for and incorporated in the management plan particularly before deciding for revascularization. In the absence of clinical manifestation like renovascular hypertension, ischemic nephropathy, left ventricular failure, or unstable coronary syndromes; mere presence of RAS is analogous to presence of concomitant peripheral arterial disease which increases risk of adverse coronary events. Dormant-RAS in the absence of any manifestations can be managed with masterly inactivity. Chronological sequence of events and clinical condition of the patient help in decision making by identifying progressive renovascular disease. Selecting patients for renal artery stenting who actually will benefit from revascularization shall also decrease the unnecessary complications inherent with any interventional procedure. The present review is an attempt to analyze the current view on the diagnostic and management issues more specifically about the need and rationale behind angioplasty.

  3. The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients

    Science.gov (United States)

    Iacoviello, Massimo; Monitillo, Francesco; Leone, Marta; Citarelli, Gaetano; Doronzo, Annalisa; Antoncecchi, Valeria; Puzzovivo, Agata; Rizzo, Caterina; Lattarulo, Maria Silvia; Massari, Francesco; Caldarola, Pasquale; Ciccone, Marco Matteo

    2016-01-01

    Background/Aim The renal arterial resistance index (RRI) is a Doppler measure, which reflects abnormalities in the renal blood flow. The aim of this study was to verify the value of RRI as a predictor of worsening renal function (WRF) in a group of chronic heart failure (CHF) outpatients. Methods We enrolled 266 patients in stable clinical conditions and on conventional therapy. Peak systolic velocity and end diastolic velocity of a segmental renal artery were obtained by pulsed Doppler flow, and RRI was calculated. Creatinine serum levels were evaluated at baseline and at 1 year, and the changes were used to assess WRF occurrence. Results During follow-up, 34 (13%) patients showed WRF. RRI was associated with WRF at univariate (OR: 1.13; 95% CI: 1.07–1.20) as well as at a forward stepwise multivariate logistic regression analysis (OR: 1.09; 95% CI: 1.03–1.16; p = 0.005) including the other univariate predictors. Conclusions Quantification of arterial renal perfusion provides a new parameter that independently predicts the WRF in CHF outpatients. Its possible role in current clinical practice to better define the risk of cardiorenal syndrome progression is strengthened. PMID:27994601

  4. Pulmonary artery radiocardiography and rheography in the diagnosis of hemodynamic and contractile function impairments of the right ventricle in patients with obstructive bronchitis

    International Nuclear Information System (INIS)

    Paleev, N.P.; Cherejskaya, N.K.; Tsar'kova, L.N.; Baklykova, S.N.; Novoderezhkina, L.B.; Oblovatskaya, O.G.; Dubinina, E.B.

    1990-01-01

    Radiocardiography and rheography of the pulmonary artery were used to examine impairments in hemodynamics and contractile function of the right ventricle in 40 patients with chronic obstructive bronchitis complicated with persistent hypertension. Right ventricular hemodynamic and contractile impairments were shown to be not equivalent with similar clinical and functional signs of pulmonary hypertension. This fact indicates that the use of special techiques is of practical value in the determination of right ventricular hemodynamics and myocardial contractility in patients with chronic obstructive bronchitis. Radiocardiography and rheography of the pulmonary artery are sufficiently reliable noninvasive techniques for examining the hemodynamics and contractile function of the right ventricular myocardium

  5. Acute upregulation of COX-2 by renal artery stenosis

    DEFF Research Database (Denmark)

    Mann, Birgitte; Hartner, A; Jensen, B L

    2001-01-01

    This study aimed to characterize the influence of acute renal artery stenosis on cyclooxygenase-2 (COX-2) and renin expression in the juxtaglomerular apparatus. For this purpose, male Sprague-Dawley rats received a left renal artery clip, and COX-2 mRNA, COX-2 immunoreactivity, plasma renin...... activity, and renin mRNA levels were determined. COX-2 mRNA and COX-2 immunoreactivity in the macula densa region in the clipped kidneys increased as early as 6 h after clipping and reached a maximal expression 1-2 days after clipping. Although values for plasma renin activity were elevated markedly at all...... time points examined, remaining renin mRNA levels were unchanged after 6 h and then increased to reach a maximum value 1-2 days after clipping. In the contralateral intact kidney, renin mRNA and COX-2 immunoreactivity decreased to approximately 50% of their normal values. To investigate a possible...

  6. Modeling of pharmacokinetics, efficacy, and hemodynamic effects of macitentan in patients with pulmonary arterial hypertension.

    Science.gov (United States)

    Krause, Andreas; Zisowsky, Jochen; Dingemanse, Jasper

    2018-04-01

    Macitentan is the first endothelin receptor antagonist with demonstrated efficacy on morbidity and mortality in pulmonary arterial hypertension (PAH) in the pivotal study SERAPHIN. The pharmacokinetics (PK) of macitentan and its active metabolite, ACT-132577, were characterized in a population model. Efficacy and hemodynamics (pharmacodynamics, PD) were related to PK based on PK/PD modeling. Sex, age, and body weight influenced the PK to a statistically significant extent. Model-based simulations showed that these variables are clinically not relevant. Concomitant use of PAH medication (PDE-5 inhibitors) did not influence macitentan trough concentration to a relevant extent. Efficacy and hemodynamics showed clear differences from placebo for macitentan concentrations on 3 and 10 mg with consistent superior effects for 10 mg. After 6 months, PAH patients showed model-predicted 6-min walk distance (6-MWD) improvements of 1.0 m on placebo compared to 29.8 and 34.1 m on 3 and 10 mg of macitentan, respectively. Higher macitentan concentrations were associated with reductions in pulmonary vascular resistance (PVR), mean right atrial and pulmonary arterial pressure, and total pulmonary resistance (TPR) and increases in cardiac index (CI) and mixed venous oxygen saturation. Statistical significance was determined for PVR, TPR, and CI but not for 6-MWD. In addition, PVR showed more pronounced differences between active treatment and placebo than 6-MWD. Modeling identified statistically significant inter-patient differences; simulations to assess the magnitude of the effects permitted clinical judgment. The same approach will allow for extrapolation to children. Hemodynamic markers might be better markers of treatment effects than 6-MWD. The SERAPHIN study and its open-label extension are registered with ClinicalTrials.gov with identifiers NCT00660179 (https://www.clinicaltrials.gov/ct2/show/NCT00660179) and NCT00667823 (https://clinicaltrials.gov/ct2/show

  7. Preoperative transcatheter renal artery embolization with absolute alcohol for the treatment of renal carcinoma: a clinical efficacy analysis

    International Nuclear Information System (INIS)

    Shang Mingyi; Wang Guoliang; Han Hongjie; Xi Qian; Huang Zongliang; Tang Junjun; Gao Xiaolong; Wang Peijun; Lu Ying; Xu Weiguo

    2010-01-01

    Objective: To access the effectiveness of preoperative transcatheter renal artery embolization with absolute alcohol performed before nephrectomy in treating renal carcinoma. Methods: Preoperative transcatheter renal artery embolization with absolute alcohol was performed in 32 patients with renal carcinoma. The renal arteries of the diseased side were progressively occluded, from distal small branches to proximal larger ones, and the renal artery trunk was embolized with gelatin sponge. Radical nephrectomy was carried out 2-5 days after the embolization procedure. The resectional rate of the tumor, the blood loss during the surgery and the operation time were recorded and analyzed. Results: Angiography performed immediately after the embolization showed that complete embolization of the main renal artery was achieved in all 32 patients. The resectional rate of the tumor was 100%. During the surgery, shrinkage of tumor, collapse of renal superficial veins and marked perinephric edema were observed. The blood loss during the surgery was much less and the operation time cost was much shorter than a usual nephrectomy did. Conclusion: The preoperative transcatheter renal artery embolization with absolute alcohol is an effective therapeutic means for renal carcinoma, it can definitely reduce the surgical blood loss and shorten the operative time. (authors)

  8. Ultrasonic Doppler measurement of renal artery blood flow

    Science.gov (United States)

    Freund, W. R.; Meindl, J. D.

    1975-01-01

    An extensive evaluation of the practical and theoretical limitations encountered in the use of totally implantable CW Doppler flowmeters is provided. Theoretical analyses, computer models, in-vitro and in-vivo calibration studies describe the sources and magnitudes of potential errors in the measurement of blood flow through the renal artery, as well as larger vessels in the circulatory system. The evaluation of new flowmeter/transducer systems and their use in physiological investigations is reported.

  9. Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia

    International Nuclear Information System (INIS)

    Sabharwal, Rohan; Vladica, Philip; Coleman, Patrick

    2007-01-01

    Objective: The aim of this study was to evaluate the role and detection rate of multidetector spiral CT renal angiography (CTA) as compared with conventional angiography (CA), the commonly accepted gold standard, in the diagnosis of renal artery fibromuscular dysplasia (FMD). In addition, the role of CTA reconstructions (multiplanar reformatted images (MPR), maximum intensity projections (MIP) and shaded-surface display (SSD)) in the detection of FMD was also evaluated. Materials and methods: CTA results were retrospectively reviewed in 21 hypertensive patients with CA-proven FMD. Clinical indications for referral included resistant hypertension (requiring greater than three antihypertensive medications), labile hypertension, hypertension in combination with renal impairment and the presence of abdominal bruits in the context of systemic hypertension. In some cases, these clinical indications were supplemented by positive results in other tests, including plasma renin assay, captopril scintigraphy and/or Doppler ultrasound. The findings of CA in these 21 patients were compared to CTA. Results: Mean patient age was 62.33 + 14.32 years (range 24-85 years). CTA identified all 42 main renal arteries (100%) and all 10 accessory renal arteries (100%) visualized on CA. In the diagnosis of FMD, CTA detected all 40 (100%) lesions detected by CA. No single CTA reconstruction technique was able to detect all lesions noted on corresponding CA, however, upon review of all CTA reconstructions (MPR, MIP and SSD) in each case, every lesion was correctly identified by CTA. Conclusion: Our experience suggests that CTA is a non-invasive, reliable and accurate method for the diagnosis of renal artery fibromuscular dysplasia. Moreover, in our experience CTA has many advantages as a diagnostic screening tool over CA, including accessibility, speed, lower complication profile, versatility and cost-effectiveness. CTA shows great potential as a guiding tool for directing subsequent

  10. Functional effects of renal artery stent placement on treated and contralateral kidneys.

    NARCIS (Netherlands)

    Leertouwer, T.C.; Derkx, F.H.M.; Pattynama, P.M.; Deinum, J.; Dijk, L.C. van; Schalekamp, M.A.D.H.

    2002-01-01

    BACKGROUND: This study examined the effects of stent placement for renal artery stenosis on the function of treated and contralateral kidneys. METHODS: Eighteen patients who underwent stent placement for unilateral renal artery stenosis presenting with hypertension and/or renal failure were studied

  11. The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Talleruphuus, U

    1997-01-01

    The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurements of downstream renal artery resistance. PI and RI have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. The aim...... of the present study was to evaluate the potential relationship between these indices and the rate of decline in renal function, as reflected by changes in different parameters of renal function in patients with chronic renal failure....

  12. Renal scintigraphy with captopril for the investigation of arterial hypertension

    International Nuclear Information System (INIS)

    Nitzsche, E.; Strauss, E.; Moser, E.; Grosser, G.; Sankt Marienkrankenhaus, Frankfurt am Main; Rump, C.; Keller, E.; Meyer, E.

    1991-01-01

    Renal artery stenosis (RAS) is a rare cause of hypertension. Radiological tests can disclose the morphological changes, but not their functional effect on renal function and perfusion. Normalization of the blood pressure can be achieved by intervention (operation, percutaneous transluminal renal angiography; PTRA), in cases of prolonged RAS-induced hypertension long-term preservation of the organ function is most important. The purpose of this study was the validation of captopril renography as a screening test for hypertension secondary to RAS prior to PTRA. Captopril renography with 99m Tc-MAG 3 has a high sensitivity (94%) and acceptable specificity (88%) for the screening of hypertensive patients. The positive predictive value is 74% and the negative predictive value 98%, compared with the 'gold standard' of angiography. (orig.) [de

  13. Arterial spin labelling in imaging of renal diseases and renal allograft pathology; MRT-Perfusionsmessung mit Arterial Spin Labelling. Anwendung fuer die Niere und Transplantatniere

    Energy Technology Data Exchange (ETDEWEB)

    Hueper, Katja; Gutberlet, Marcel [Medizinische Hochschule Hannover (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Kuehn, Bernd [Siemens AG/Siemens Healthcare GmbH, Erlangen (Germany)

    2016-06-15

    Arterial Spin Labelling (ASL) is a technique for non-invasive and contrast-free assessment of perfusion with MRI. Renal ASL allows examination of renal pathophysiology, evaluation of the course of renal disease and therapy effects by longitudinal measurements as well as characterization of renal tumors. In this article, techniques of ASL will be explained and challenges of renal ASL will be emphasized. In addition, examples for clinical application of ASL for diagnosis of renal disease and renal allograft pathology will be given.

  14. Value of downstream circulation in renal artery stenosis with arterial hypertension: comparison between color Doppler flow and digital renal angiography in 123 patients

    International Nuclear Information System (INIS)

    Grataloup, C.; Challande, P.; Plainfosse, M.C.; Girerd, X.; Belattar, K.; Plouin, P.F.

    1996-01-01

    Digital renal angiography and color Doppler flow were compared for diagnosis of renal artery stenosis in 123 hypertensive patients with a prevalence of renal artery stenosis ≥75% of 21 %. Only color Doppler flow signs found downstream from the stenosis could be quantified. A rising time (RT) >0.07 s was the best marker for renal artery stenosis ≥ 75 % according to a receiver operating characteristic curve with a specificity of 97 %, a sensitivity of 88 %, a positive predictive value of 86 %, a negative predictive value of 98 % and an accuracy of 96 %. Digital renal angiography and color Doppler flow findings for renal artery lesions were classified into 4 degrees with agreement for 86 % of the kidneys. (authors). 13 refs., 5 figs., 8 tabs

  15. Bone metabolism and arterial stiffness after renal transplantation.

    Science.gov (United States)

    Cseprekál, Orsolya; Kis, Eva; Dégi, Arianna A; Kerti, Andrea; Szabó, Attila J; Reusz, György S

    2014-01-01

    To assess the relationship between bone and vascular disease and its changes over time after renal transplantation. Metabolic bone disease (MBD) is common in chronic kidney disease (CKD) and is associated with cardiovascular (CV) disease. Following transplantation (Tx), improvement in CV disease has been reported; however, data regarding changes in bone disease remain controversial. Bone turnover and arterial stiffness (pulse wave velocity (PWV)) were assessed in 47 Tx patients (38 (3-191) months after Tx). Bone alkaline phosphatase (BALP), osteocalcin (OC) and beta-crosslaps were significantly higher in Tx patients, and decreased significantly after one year. There was a negative correlation between BALP, OC and steroid administered (r = -0.35; r = -0.36 respectively). PWV increased in the Tx group (1.15 SD). In patients with a follow up of bone turnover and arterial stiffness are present following kidney transplantation. While bone turnover decreases with time, arterial stiffness correlates initially with bone turnover, after which the influence of cholesterol becomes significant. Non-invasive estimation of bone metabolism and arterial stiffness may help to assess CKD-MBD following renal transplantation.

  16. Physical Training, Hemodynamic Parameters and Arterial Stiffness: Friends or Foes of the Hypertensive Patient?

    Science.gov (United States)

    Iurciuc, Stela; Avram, Claudiu; Turi, Vladiana; Militaru, Anda; Avram, Adina; Cimpean, Anca Maria; Iurciuc, Mircea

    2016-01-01

    To evaluate the impact of physical training on central hemodynamic parameters and elasticity of large arteries in hypertensive patients. A total of 129 hypertensive patients were divided into two groups: group A followed lifestyle changes and physical training; and group B acted as a control group; seven parameters were recorded: Pulse wave velocity (PWVao), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), central aortic systolic blood pressure (SBPao), aortic diastolic blood pressure (DBPao), and central aortic pulse pressure (PPao). The difference between values at 4 months and baseline (Δ) were as follows: ΔPWVao was -1.02 m/s (p<0.001) versus 0.17 m/s (p=0.035), ΔSBPao was -9.6 mmHg (p=0.009) versus 1.6 mmHg (p=0.064), and ΔPPao was -6.8 mmHg (p<0.001) versus 3.2 mmHg, (p=0.029) in group A versus B, respectively. Exercise training improves SBP, PP, SBPao, PPao and may delay arterial ageing. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  17. Renal Dysfunction after Off-Pump Coronary Artery Bypass Surgery- Risk Factors and Preventive Strategies

    Directory of Open Access Journals (Sweden)

    Gaurab Maitra

    2009-01-01

    Full Text Available Postoperative renal dysfunction is a relatively common and one of the serious complications of cardiac surgery. Though off-pump coronary artery bypass surgery technique avoids cardiopulmonary bypass circuit induced adverse effects on renal function, multiple other factors cause postoperative renal dysfunction in these groups of patients. Acute kidney injury is generally defined as an abrupt and sustained decrease in kidney function. There is no consen-sus on the amount of dysfunction that defines acute kidney injury, with more than 30 definitions in use in the literature today. Although serum creatinine is widely used as a marker for changes in glomerular filtration rate, the criteria used to define renal dysfunction and acute renal failure is highly variable. The variety of definitions used in clinical studies may be partly responsible for the large variations in the reported incidence. Indeed, the lack of a uniform definition for acute kidney injury is believed to be a major impediment to research in the field. To establish a uniform definition for acute kidney injury, the Acute Dialysis Quality Initiative formulated the Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE classification. RIFLE , defines three grades of increasing severity of acute kidney injury -risk (class R, injury (class I and failure (class F - and two outcome classes (loss and end-stage kidney disease. Various perioperative risk factors for postoperative renal dysfunction and failure have been identified. Among the important preoperative factors are advanced age, reduced left ventricular function, emergency surgery, preoperative use of intraaortic balloon pump, elevated preoperative serum glucose and creatinine. Most important intraoperative risk factor is the intraoperative haemodynamic instability and all the causes of postoperative low output syndrome com-prise the postoperative risk factors. The most important preventive strategies are the identification of the

  18. Cigarette smoking and cardio-renal events in patients with atherosclerotic renal artery stenosis.

    Directory of Open Access Journals (Sweden)

    Christopher A Drummond

    Full Text Available Cigarette smoking causes cardiovascular disease and is associated with poor kidney function in individuals with diabetes mellitus and primary kidney diseases. However, the association of smoking on patients with atherosclerotic renal artery stenosis has not been studied. The current study utilized data from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL, NCT00081731 clinical trial to evaluate the effects of smoking on the risk of cardio-renal events and kidney function in this population. Baseline data showed that smokers (n = 277 out of 931 were significantly younger at enrollment than non-smokers (63.3±9.1 years vs 72.4±7.8 years; p<0.001. In addition, patients who smoke were also more likely to have bilateral renal artery stenoses and peripheral vascular disease (PVD. Longitudinal analysis showed that smokers experienced composite endpoint events (defined as first occurrence of: stroke; cardiovascular or renal death; myocardial infarction; hospitalization for congestive heart failure; permanent renal replacement; and progressive renal insufficiency defined as 30% reduction of GFR from baseline sustained for ≥ 60 days at a substantially younger age compared to non-smokers (67.1±9.0 versus 76.1±7.9, p<0.001. Using linear regression and generalized linear modeling analysis controlled by age, sex, and ethnicity, smokers had significantly higher cystatin C levels (1.3±0.7 vs 1.2±0.9, p<0.01 whereas creatinine and estimated glomerular filtration rate (eGFR were not different from non-smokers. From these data we conclude that smoking has a significant association with deleterious cardio-renal outcomes in patients with renovascular hypertension.

  19. The effect of acute maximal exercise on postexercise hemodynamics and central arterial stiffness in obese and normal-weight individuals.

    Science.gov (United States)

    Bunsawat, Kanokwan; Ranadive, Sushant M; Lane-Cordova, Abbi D; Yan, Huimin; Kappus, Rebecca M; Fernhall, Bo; Baynard, Tracy

    2017-04-01

    Central arterial stiffness is associated with incident hypertension and negative cardiovascular outcomes. Obese individuals have higher central blood pressure (BP) and central arterial stiffness than their normal-weight counterparts, but it is unclear whether obesity also affects hemodynamics and central arterial stiffness after maximal exercise. We evaluated central hemodynamics and arterial stiffness during recovery from acute maximal aerobic exercise in obese and normal-weight individuals. Forty-six normal-weight and twenty-one obese individuals underwent measurements of central BP and central arterial stiffness at rest and 15 and 30 min following acute maximal exercise. Central BP and normalized augmentation index (AIx@75) were derived from radial artery applanation tonometry, and central arterial stiffness was obtained via carotid-femoral pulse wave velocity (cPWV) and corrected for central mean arterial pressure (cPWV/cMAP). Central arterial stiffness increased in obese individuals but decreased in normal-weight individuals following acute maximal exercise, after adjusting for fitness. Obese individuals also exhibited an overall higher central BP ( P  <   0.05), with no exercise effect. The increase in heart rate was greater in obese versus normal-weight individuals following exercise ( P  <   0.05), but there was no group differences or exercise effect for AIx@75 In conclusion, obese (but not normal-weight) individuals increased central arterial stiffness following acute maximal exercise. An assessment of arterial stiffness response to acute exercise may serve as a useful detection tool for subclinical vascular dysfunction. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

  20. Arterial aging and arterial disease : interplay between central hemodynamics, cardiac work, and organ flow-implications for CKD and cardiovascular disease

    NARCIS (Netherlands)

    London, Gerard; Covic, Adrian; Goldsmith, David; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Fliser, Danilo; Agarwal, Rajiv; Jager, Kitty J.; Dekker, Friedo W.; Blankestijn, Peter J.; Zoccali, Carmine

    Cardiovascular disease is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). All epidemiological studies have clearly shown that accelerated arterial and cardiac aging is characteristic of these populations. Arterial

  1. Hemodynamic and clinical onset in patients with hereditary pulmonary arterial hypertension and BMPR2 mutations

    Directory of Open Access Journals (Sweden)

    Tiede Henning

    2011-07-01

    Full Text Available Abstract Background Mutations in the bone morphogenetic protein receptor 2 (BMPR2 gene can lead to idiopathic pulmonary arterial hypertension (IPAH. This study prospectively screened for BMPR2 mutations in a large cohort of PAH-patients and compared clinical features between BMPR2 mutation carriers and non-carriers. Methods Patients have been assessed by right heart catheterization and genetic testing. In all patients a detailed family history and pedigree analysis have been obtained. We compared age at diagnosis and hemodynamic parameters between carriers and non-carriers of BMPR2 mutations. In non-carriers with familial aggregation of PAH further genes/gene regions as the BMPR2 promoter region, the ACVRL1, Endoglin, and SMAD8 genes have been analysed. Results Of the 231 index patients 22 revealed a confirmed familial aggregation of the disease (HPAH, 209 patients had sporadic IPAH. In 49 patients (86.3% of patients with familial aggregation and 14.3% of sporadic IPAH mutations of the BMPR2 gene have been identified. Twelve BMPR2 mutations and 3 unclassified sequence variants have not yet been described before. Mutation carriers were significantly younger at diagnosis than non-carriers (38.53 ± 12.38 vs. 45.78 ± 11.32 years, p Conclusion This study identified in a large prospectively assessed cohort of PAH- patients new BMPR2 mutations, which have not been described before and confirmed previous findings that mutation carriers are younger at diagnosis with a more severe hemodynamic compromise. Thus, screening for BMPR2 mutations may be clinically useful.

  2. Magnetic resonance angiography signal intensity as a marker of hemodynamic impairment in intracranial arterial stenosis.

    Directory of Open Access Journals (Sweden)

    Xinyi Leng

    Full Text Available Intracranial arterial stenosis (ICAS is the predominant cause of ischemic stroke and transient ischemic attack in Asia. Change of signal intensities (SI across an ICAS on magnetic resonance angiography (MRA may reflect its hemodynamic severity.In-patients with a symptomatic single ICAS detected on 3D time-of-flight MRA were recruited from 2 hospitals. Baseline and 1-year follow-up data were collected. Signal intensity ratio (SIR [ =  (mean post-stenotic SI -mean background SI/(mean pre-stenotic SI - mean background SI] was evaluated on baseline MRA to represent change of SIs across an ICAS. Acute infarct volume was measured on baseline diffusion-weighted images (DWI. Relationships between SIR and baseline characteristics as well as 1y outcomes were evaluated.Thirty-six subjects (86.1% males, mean age 55.0 were recruited. Overall, mean SIR was 0.84±0.23. Mean SIRs were not significantly different between the 23 (63.9% anatomically severe stenoses and the 13 (36.1% anatomically moderate stenoses (0.80±0.23 versus 0.92±0.21, p = 0.126. SIR was significantly, linearly and negatively correlated to acute infarct volume on DWI (Spearman correlation coefficient -0.471, p = 0.011. Two patients (5.6% had recurrent ischemic strokes at 1y, not related to SIR values.Change of signal intensities across an ICAS on MRA may reflect its hemodynamic and functional severity. Future studies are warranted to further verify the relationships between this index and prognosis of patients with symptomatic ICAS.

  3. Renal blood flow, diuresis and isotope nephrogram in experimental stenosis of the renal artery

    International Nuclear Information System (INIS)

    Pemsel, H.K.; Lange, H.; Mahlstedt, J.; Joseph, K.; Marburg Univ.; Marburg Univ.

    1979-01-01

    After experimental stenosis of the renal artery of the dog, the isotope nephrogram shows a prolongation of the transit-time, when the renal blood flow is reduced to 40-70%. This finding was most significant in low diuresis (0,05-0,2 ml/min), sporadic in moderate diuresis (0,2-2,0 ml/min), no longer demonstrable in forced diuresis (>2,0 ml/min). The diuretic effect of X-ray contrast-medium (70% Na-Meglumin-Jotalamat, 0,5 ml/kg i.v.) normalizes a pathologic ING in low diuresis. (orig.) [de

  4. Detection of renal arteries with fast spin-echo magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tello, R.; Mitchell, P.J.; Witte, D.J.; Thomson, K.R. [University of Melbourne, Parkville, VIC (Australia). Department of Radiology

    1998-08-01

    With the increasing use of non-invasive imaging with MR and volumetric CT to evaluate renal arteries, the ability to accurately detect the number and state of native renal arteries becomes critical if conventional angiography is to be supplanted in these settings. The present study evaluated the utility of a fast spin-echo (FSE) T2-weighted sequence to detect the number and course of renal arteries and their ostia compared to conventional angiography. Ten patients underwent conventional catheter angiography either for renal artery stenosis evaluation or as potential renal donors. Each patient then had an MR study of the renal arteries and kidneys with FSE MR (TR = 4000 ms, TE = 102 ms, eight- echo train length, 5-mm-thick interleaved 128 phase encodes, superior and inferior saturation pulses, number of excitations (NEX) = 4, on a 1.5-T superconducting magnet). Images were reviewed by two `blinded` radiologists and renal arteries were counted and their ostia were evaluated. Results were compared with angiography and inter- and intra-observer statistics were calculated. All 10 patients underwent MR successfully, nine for renal artery stenosis (RAS) evaluation and one was a renal donor. A total of 24 renal arteries were imaged in 19 kidneys. Fast spin-echo MR is 95% accurate (95%CI: 88-100%) in detection of renal arteries, with no statistical difference between FSE MR and catheter angiography (McNemar P = 0.0). Inter- and intra-observer statistics demonstrate good-to-excellent agreement in renal artery detection (kappa: 0.63-0.90). In one case of RAS evaluation an incidental adrenal mass was detected as the aetiology of the patient`s hypertension. Fast spin-echo MR can be a useful adjunct as part of the imaging for renal arteries with MRI. Copyright (1998) Blackwell Science Pty Ltd 16 refs., 1 fig.

  5. Detection of renal arteries with fast spin-echo magnetic resonance imaging

    International Nuclear Information System (INIS)

    Tello, R.; Mitchell, P.J.; Witte, D.J.; Thomson, K.R.

    1998-01-01

    With the increasing use of non-invasive imaging with MR and volumetric CT to evaluate renal arteries, the ability to accurately detect the number and state of native renal arteries becomes critical if conventional angiography is to be supplanted in these settings. The present study evaluated the utility of a fast spin-echo (FSE) T2-weighted sequence to detect the number and course of renal arteries and their ostia compared to conventional angiography. Ten patients underwent conventional catheter angiography either for renal artery stenosis evaluation or as potential renal donors. Each patient then had an MR study of the renal arteries and kidneys with FSE MR (TR = 4000 ms, TE = 102 ms, eight- echo train length, 5-mm-thick interleaved 128 phase encodes, superior and inferior saturation pulses, number of excitations (NEX) = 4, on a 1.5-T superconducting magnet. Images were reviewed by two 'blinded' radiologists and renal arteries were counted and their ostia were evaluated. Results were compared with angiography and inter- and intra-observer statistics were calculated. All 10 patients underwent MR successfully, nine for renal artery stenosis (RAS) evaluation and one was a renal donor. A total of 24 renal arteries were imaged in 19 kidneys. Fast spin-echo MR is 95% accurate (95%CI: 88-100%) in detection of renal arteries, with no statistical difference between FSE MR and catheter angiography (McNemar P = 0.0). Inter- and intra-observer statistics demonstrate good-to-excellent agreement in renal artery detection (kappa: 0.63-0.90). In one case of RAS evaluation an incidental adrenal mass was detected as the aetiology of the patient's hypertension. Fast spin-echo MR can be a useful adjunct as part of the imaging for renal arteries with MRI. Copyright (1998) Blackwell Science Pty Ltd

  6. Non-invasive prediction of hemodynamically significant coronary artery stenoses by contrast density difference in coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Hell, Michaela M., E-mail: michaela.hell@uk-erlangen.de [Department of Cardiology, University of Erlangen (Germany); Dey, Damini [Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Taper Building, Room A238, 8700 Beverly Boulevard, Los Angeles, CA 90048 (United States); Marwan, Mohamed; Achenbach, Stephan; Schmid, Jasmin; Schuhbaeck, Annika [Department of Cardiology, University of Erlangen (Germany)

    2015-08-15

    Highlights: • Overestimation of coronary lesions by coronary computed tomography angiography and subsequent unnecessary invasive coronary angiography and revascularization is a concern. • Differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve, were assessed. • At a threshold of ≥24%, contrast density difference predicted hemodynamically significant lesions with a specificity of 75%, sensitivity of 33%, PPV of 35% and NPV of 73%. • The determination of contrast density difference required less time than transluminal attenuation gradient measurement. - Abstract: Objectives: Coronary computed tomography angiography (CTA) allows the detection of obstructive coronary artery disease. However, its ability to predict the hemodynamic significance of stenoses is limited. We assessed differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve (FFR). Methods: Lesion characteristics of 59 consecutive patients (72 lesions) in whom invasive FFR was performed in at least one coronary artery with moderate to high-grade stenoses in coronary CTA were evaluated by two experienced readers. Coronary CTA data sets were acquired on a second-generation dual-source CT scanner using retrospectively ECG-gated spiral acquisition or prospectively ECG-triggered axial acquisition mode. Plaque volume and composition (non-calcified, calcified), remodeling index as well as contrast density difference (defined as the percentage decline in luminal CT attenuation/cross-sectional area over the lesion) were assessed using a semi-automatic software tool (Autoplaq). Additionally, the transluminal attenuation gradient (defined as the linear regression coefficient between intraluminal CT attenuation and length from the ostium) was determined

  7. Interventional treatment of renal artery stenosis: a mid-term evaluation of clinical efficacy

    International Nuclear Information System (INIS)

    Liu Jing; Zhang Xitong

    2009-01-01

    Objective: To assess the clinical efficacy of interventional management for the treatment of renal artery stenosis. Methods: Percutaneous transluminal balloon renal angioplasty and / or percutaneous transluminal renal artery stenting were performed in 47 patients with renal artery stenosis (55 stenosed arteries in total). A follow-up study on the blood pressure and renal function was conducted and the results were statistically analyzed. Results: Fifty-four stenosed renal arteries were successfully reopened, of which only percutaneous transluminal balloon angioplasty was adopted in 17 and percutaneous transluminal renal artery stenting in 37. One patient died during the procedure. A follow-up for a mean period of (2.5 ± 0.6) years was carried out. The blood pressure determined at one (n = 46), 6 (n = 46), 12 (n = 33) and 24 (n = 29) months after the treatment was significantly decreased when compared to that determined before the treatment (P < 0.01). The clinical effective rate was 89.13% (41 / 46), 72.73% (24 / 33) and 62.07% (18 / 29), respectively. After the therapy,the renal function was improved in 5, remained unchanged in 33 and became worse in 3 patients. The comparison of the post-operative renograms (obtained within 2 months) with the pre-operative ones showed that in eight patients there was an increase in renal blood flow with an improvement in renal function impairment, which took a turn from severe degree to mild or moderate degree. Nevertheless, severe impairment in renal blood flow remained in 3 patients. Conclusion: Percutaneous transluminal balloon renal angioplasty and percutaneous transluminal renal artery stenting are safe and effective treatments for the renal artery stenosis, which also has a beneficial effect on the related renal hypertension and renal insufficiency. (authors)

  8. Renal embolic protection devices improve blood flow after stenting for atherosclerotic renal artery stenosis.

    Science.gov (United States)

    Paul, Timir K; Lee, John H; White, Christopher J

    2012-11-15

    We sought to measure angiographic renal frame counts (RFC), as a quantitative angiographic assessment of renal blood flow, to evaluate microvascular compromise due to atheroembolism associated with RAS. Atheroembolism associated with renal artery stenting (RAS) has been implicated as a cause for worsening renal function following successful intervention. Use of a distal embolic protection device (EPD) during RAS has been shown to be safe with debris capture in a high percentage of cases. However, objective benefit for renal function with EPD has been difficult to demonstrate. A control group of 30 consecutive patients (33 kidneys) who underwent RAS without EPD were compared with 33 consecutive patients (33 kidneys) who underwent RAS with EPD using RFC measurement. The prestent and poststent mean RFC for the control group was 30.4 ± 12.1 vs. 23.7 ± 9.9 (P = 0.002) and for the EPD group it was 42.6 ± 12.6 vs. 28.3 ± 9.2 (P renal blood flow, manifested by a greater reduction of the RFC (Δ RFC) 14.2 ± 15.2 vs. 6.7 ± 11.7 (P = 0.03) compared with the control group. The use of an EPD was associated with a much larger improvement in renal blood flow (lower RFC) following RAS. This suggests that EPD's may be effective in preventing renal atheroembolic injury and that a controlled trial measuring the impact of EPD's on renal blood flow following RAS should be performed. Copyright © 2012 Wiley Periodicals, Inc.

  9. Cerebral hemodynamics in adult ischemic-type patients with moyamoya disease compared with those of atherothrombotic middle cerebral artery occlusion

    International Nuclear Information System (INIS)

    Idei, Masaru; Yamane, Kanji; Nishida, Masahiro; Manabe, Kazufumi; Yokota, Akira

    2005-01-01

    We measured regional cerebral blood flow (rCBF) in adult ischemic-type patients with moyamoya disease and in patients with atherothrombotic middle cerebral artery occlusion (MCAO) to investigate cerebral hemodynamics in adult ischemic-type of moyamoya disease. In this study we measured rCBF and regional cerebro-vascular response (rCVR) using acetazolamide by Xe-non-enhanced CT. Our subjects consisted of 15 adult ischemic-type patients with moyamoya disease and 27 atherothrombotic stroke patients with proximal occlusion of the middle cerebral artery. The region of inter est was conducted in the anterior cerebral artery, middle cerebral artery and posterior cerebral artery territories as well as basal ganglia regions. rGBF was preserved in all regions of patients with moyamoya disease. However, rCVR severely decreased in the anterior circulation territory in patients with moyamoya disease compared with those of MCAO. These results suggest that rCBF in the anterior circulation territory of adult ischemic-type patients with moyamoya disease is preserved by vasodilation of the cerebral arteries, while cerebral hemodynamic reserve capacity is severely reduced. The results indicated that basal moyamoya vessels are dilated. These findings may be one of the reasons why stroke occurs more frequently in adult than child patients with moyamoya disease. (author)

  10. Stent sizing strategies in renal artery stenting: the comparison of conventional invasive renal angiography with renal computed tomographic angiography.

    Science.gov (United States)

    Kadziela, Jacek; Michalowska, Ilona; Pregowski, Jerzy; Janaszek-Sitkowska, Hanna; Lech, Katarzyna; Kabat, Marek; Staruch, Adam; Januszewicz, Andrzej; Witkowski, Adam

    2016-01-01

    Randomized trials comparing invasive treatment of renal artery stenosis with standard pharmacotherapy did not show substantial benefit from revascularization. One of the potential reasons for that may be suboptimal procedure technique. To compare renal stent sizing using two modalities: three-dimensional renal computed tomography angiography (CTA) versus conventional angiography. Forty patients (41 renal arteries), aged 65.1 ±8.5 years, who underwent renal artery stenting with preprocedural CTA performed within 6 months, were retrospectively analyzed. In CTA analysis, reference diameter (CTA-D) and lesion length (CTA_LL) were measured and proposed stent diameter and length were recorded. Similarly, angiographic reference diameter (ANGIO_D) and lesion length (ANGIO_LL) as well as proposed stent dimensions were obtained by visual estimation. The median CTA_D was 0.5 mm larger than the median ANGIO_D (p < 0.001). Also, the proposed stent diameter in CTA evaluation was 0.5 mm larger than that in angiography (p < 0.0001). The median CTA_LL was 1 mm longer than the ANGIO_LL (p = NS), with significant correlation of these variables (r = 0.66, p < 0.0001). The median proposed stent length with CTA was equal to that proposed with angiography. The median diameter of the implanted stent was 0.5 mm smaller than that proposed in CTA (p < 0.0005) and identical to that proposed in angiography. The median length of the actual stent was longer than that proposed in angiography (p = 0.0001). Renal CTA has potential advantages as a tool adjunctive to angiography in appropriate stent sizing. Careful evaluation of the available CTA scans may be beneficial and should be considered prior to the planned procedure.

  11. Time-resolved MR angiography of the renal artery: morphology and perfusion

    International Nuclear Information System (INIS)

    Krause, U.J.; Pabst, T.; Koestler, H.; Helbig, C.; Kenn, W.; Hahn, D.

    2002-01-01

    Purpose: To prove the hypothesis that renal artery stenosis and changes in renal perfusion can be detected with contrast-enhanced time-resolved MR angiography in a single examination. Material and Methods: In 71 patients, 137 renal arteries and 14 accessory renal arteries were studied. The examinations were performed on a 1.5 T system. A T 1 -weighted gradient echo sequence with a temporal resolution of 7 s was used. Single dose of contrast material (0.1 mmol/kg Gd-DTPA) was injected with a power injector with a flow rate of 2 ml/s. Criterion for the assessment of renal perfusion was the slope ratio of the signal intensity time curve in both kidneys. Results: Forty renal artery stenoses and one occlusion of a renal artery were detected. In 48 kidneys (35%) segmental arteries were evaluated. The accuracy of the slope ratio (limit value 0.75) concerning the detection of unilateral renal artery stenosis was 92.6% (sensitivity 75%, specificity 95.7%). Conclusion: Time-resolved MR angiography can detect changes in renal perfusion in patients with unilateral renal artery stenosis. (orig.) [de

  12. Severe Hypertension Secondary to Renal Artery Stenosis and Cushing's Syndrome

    International Nuclear Information System (INIS)

    Al-Zahrani, Ali S.; Al-Hajjaj, Alya; Al-Watban, Jehad; Kanaan, Imaduddin

    2005-01-01

    We present an unusual patient who simultaneously had severe renal artery stenosis RAS and Cushings syndrome. The case highlights the difficulty of reaching a specific diagnosis of Cushings syndrome and the possible interaction between Cushings syndrome and some other concurrent illnesses that this patient had. A 37-year old man presented with severe hypertension HTN and uncontrolled diabetes mellitus DM without clear physical signs of Cushings syndrome. He was found to have severe osteoporosis, proximal myopathy, several cutaneous warts, tinea versicolor, and chronic viral hepatitis. Captopril-stimulated renal scan and renal artery angiogram revealed severe RAS. Partial balloon dilatation of RAS led to improvement in HTN. Unexpectedly, urine free cortisol 24 hour was found extremely high. Serum adrenocorticotropic hormone ACTH was also elevated and high dose dexamethasone suppression tests were inconclusive. Several imaging studies failed to localize the source of ACTH. Despite normal MRI of the pituitary gland, bilateral inferior petrosal sinus sampling IPSS localized the source of ACTH secretion to the right side of the pituitary gland and right anterior hemihypophysectomy resulted in cure of Cushings disease, HTN, DM, and tinea versicolor with significant improvement in cutaneous warts, osteoporosis, and chronic hepatitis. In conclusion, RAS and Cushings syndrome may occur together. Significant hypercortisolemia can occur without clear signs of Cushings syndrome. Controlling hypercortisolemia is of paramount importance when treating chronic infections in patients with Cushing's syndrome. (author)

  13. Renal artery stent fracture with refractory hypertension: a case report and review of the literature.

    Science.gov (United States)

    Chua, Su-Kiat; Hung, Huei-Fong

    2009-07-01

    A 73-year-old man with resistant hypertension and impaired renal function underwent stenting for right renal artery (RRA) stenosis. Two years later, he presented with uncontrolled hypertension and worse renal function. Renal arteriogram revealed RRA stent fracture with in-stent restenosis. Another stent was deployed. Four months later, however, renal arteriogram revealed in-stent restenosis again. This time, balloon angioplasty alone was performed. He had been symptom-free with stable condition at 2-year follow-up. A literature review disclosed six renal artery stent fracture cases, including the present one, who developed in-stent stenosis resulted from stent fracture. Two major anatomy features of renal artery stenosis were suggestive for development of stent fracture: (1) renal artery entrapment by diaphragmatic crus, and (2) mobile kidney with acute angulation at proximal segment of the renal artery. It is important to detect this etiology of renal artery stenosis because stenting in these vessels may contribute to in-stent restenosis or stent fracture. Management of renal artery stent fracture, including endovascular treatment or aortorenal bypass, should be considered on a case-by-case basis in relation to clinical settings. Copyright 2009 Wiley-Liss, Inc.

  14. Suprarenal fixation barbs can induce renal artery occlusion in endovascular aortic aneurysm repair.

    Science.gov (United States)

    Subedi, Shree K; Lee, Andy M; Landis, Gregg S

    2010-01-01

    Renal artery occlusion following endovascular abdominal aortic aneurysm repair with suprarenal fixation is uncommon. We report one patient who was found to develop renal artery occlusion and parenchymal infarction 6 months after repair using an endovascular graft with suprarenal fixation. Our patient underwent emergent endovascular repair of a symptomatic 6 cm abdominal aortic aneurysm. The covered portion of the endograft was inadvertently deployed well below the renal artery orifices. At the completion of the procedure both renal arteries were confirmed to be patent. One month postoperatively, a computed tomographic (CT) scan showed exclusion of the aortic sac and normal enhancement of both kidneys. At 6 months, the patient was found to have elevated serum creatinine levels despite having no clinical symptoms. CT scanning revealed a nonenhancing left kidney, and angiography demonstrated an occlusion of the left renal artery. A barb welded to the bare metal stent appeared to be impinging on the renal artery. We believe that renal artery occlusion after endovascular repair can occur due to repetitive injury to the renal artery orifice from barbs welded to the bare metal stent. To our knowledge, this is the first reported case of renal artery occlusion caused by repetitive injury from transrenal fixation systems. Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  15. The angiographic incidence of renal artery stenosis in the arterioscleritic population

    International Nuclear Information System (INIS)

    Wils, G.; Marchal, G.; Peene, P.; Baert, A.L.

    1990-01-01

    The incidence of renal artery stenosis was evaluated with intra-arterial digital subtraction anghiography in 100 consecutive patients referred for peripheral arteriopathy. Fifty-seven patients were normotensive, 43 were hypertensive. In the normotensive group, renal artery stenosis was found in ten patients (17.5%). In the hypertensive group renal artery stenosis was found in twelve patients (28%). It is concluded that the incidence of renal aretery stenosis is high in an arterioslcerotic population both in normotensive and hypertensive patients. (author). 16 refs.; 1 tab

  16. TRANS-ARTERIAL EMBOLIZATION WITH N-BUTYL CYANOACRYLATE GLUE FOR RENAL BLEEDING: Case Report

    Directory of Open Access Journals (Sweden)

    Benny Young

    2014-08-01

    Full Text Available Background: The objectivity in management of renal bleeding is to preserve a significant renal parenchyma tissue and prevent associated morbidities like anemic shock or renal impairment from substantial nephron demise or obstructed uropathy. Trans-arterial embolization therapy by interventional radiology offers a high success rate with potential of reserving normal renal tissue. The selection material for renal arterial embolization largely depends on vasculature anatomy and end-point of procedure. N-butyl cyanoacrylate glue in our experience is applied in lesion supplied by small size of end-artery

  17. Salvage of bilateral renal artery occlusion after endovascular aneurysm repair with open splenorenal bypass

    Directory of Open Access Journals (Sweden)

    Samuel Jessula, MDCM

    2017-09-01

    Full Text Available We report renal salvage maneuvers after accidental bilateral renal artery coverage during endovascular aneurysm repair of an infrarenal abdominal aortic aneurysm. A 79-year-old man with an infrarenal abdominal aortic aneurysm was treated with endovascular aneurysm repair. Completion angiography demonstrated coverage of the renal arteries. Several revascularization techniques were attempted, including endograft repositioning and endovascular stenting through the femoral and brachial approach. The patient eventually underwent open splenorenal bypass with a Y Gore-Tex graft (W. L. Gore & Associates, Flagstaff, Ariz. After 3 months, computed tomography showed no evidence of endoleak and patent renal arteries. Renal function was well maintained, and the patient did not require dialysis.

  18. Idiopathic renal hematuria in a dog; the usefulness of a method of partial occlusion of the renal artery.

    Science.gov (United States)

    Mishina, M; Watanabe, T; Yugeta, N; Maeda, H; Fujii, K; Wakao, Y; Takahashi, M; Yamamura, H

    1997-04-01

    Exploratory laparotomy was performed on a dog suspected of having idiopathic renal hematuria. Two catheters were inserted into the bilateral ureters, and hematuria from the left kidney was confirmed. The blood flow was occluded in the ventral and dorsal rami of the left renal artery in order to localize the site of hemorrhage. As hematuria disappeared when the dorsal ramus was occluded, the site of renal hematuria was localized to the area dominated by the dorsal ramus of the renal artery. As a result of ligating the dorsal ramus of the left renal artery in this dog, renal hematuria subsided, and the dog has shown a favorable course, to date, one year after surgery.

  19. Study of the renal segmental arterial anatomy with contrast-enhanced multi-detector computed tomography.

    Science.gov (United States)

    Rocco, Francesco; Cozzi, Luigi Alberto; Cozzi, Gabriele

    2015-07-01

    To use triphasic multi-detector computed tomography (MDCT) to study the renal segmental arterial anatomy and its relationship with the urinary tract to plan nephron-sparing surgery (NSS). One hundred and fifty nine patients underwent abdominal contrast-enhanced MDCT. We evaluated renal arteries and parenchymal vasculature. In 61 patients, the arteries and the urinary tract were represented simultaneously. 86.60% presented a single renal artery; 13.4%, multiple arteries. All single renal arteries divided into anterior and posterior branch before the hilum. The anterior artery branched into a superior, middle, and inferior branch. In 43.14%, the inferior artery arose before the others; in 45.75%, the superior artery arose before the others; in 9.80%, the branches shared a common trunk. In 26.80%, the posterior artery supplies the entire posterior surface; in 73.20%, it ends along the inferior calyx. In 96.73%, the upper pole was vascularized by the anterior superior branch and the posterior artery: the "tuning fork". MDCT showed four vascular segments in 96.73% and five in 3.27%. MDCT showed two avascular areas: the first along the projection of the inferior calyx on the posterior aspect, the second between the branches of the "tuning fork". The arterial phase provides the arterial tree representation; the delayed phase shows arteries and urinary tract simultaneously. MDCT provides a useful representation of the renal anatomy prior to intervascular-intrarenal NSS.

  20. Efficacy and safety of catheter-based radiofrequency renal denervation in stented renal arteries.

    Science.gov (United States)

    Mahfoud, Felix; Tunev, Stefan; Ruwart, Jennifer; Schulz-Jander, Daniel; Cremers, Bodo; Linz, Dominik; Zeller, Thomas; Bhatt, Deepak L; Rocha-Singh, Krishna; Böhm, Michael; Melder, Robert J

    2014-12-01

    In selected patients with hypertension, renal artery (RA) stenting is used to treat significant atherosclerotic stenoses. However, blood pressure often remains uncontrolled after the procedure. Although catheter-based renal denervation (RDN) can reduce blood pressure in certain patients with resistant hypertension, there are no data on the feasibility and safety of RDN in stented RA. We report marked blood pressure reduction after RDN in a patient with resistant hypertension who underwent previous stenting. Subsequently, radiofrequency ablation was investigated within the stented segment of porcine RA, distal to the stented segment, and in nonstented RA and compared with stent only and untreated controls. There were neither observations of thrombus nor gross or histological changes in the kidneys. After radiofrequency ablation of the nonstented RA, sympathetic nerves innervating the kidney were significantly reduced, as indicated by significant decreases in sympathetic terminal axons and reduction of norepinephrine in renal tissue. Similar denervation efficacy was found when RDN was performed distal to a renal stent. In contrast, when radiofrequency ablation was performed within the stented segment of the RA, significant sympathetic nerve ablation was not seen. Histological observation showed favorable healing in all arteries. Radiofrequency ablation of previously stented RA demonstrated that RDN provides equally safe experimental procedural outcomes in a porcine model whether the radiofrequency treatment is delivered within, adjacent, or without the stent struts being present in the RA. However, efficacious RDN is only achieved when radiofrequency ablation is delivered to the nonstented RA segment distal to the stent. © 2014 American Heart Association, Inc.

  1. The origin of extrarenal arterial blood supply of renal malignancy and its clinical value

    International Nuclear Information System (INIS)

    Du Duanming; Tong Xiaoqiang; Song Li; Zou Yinghua

    2007-01-01

    Objective: To study the mechanisms of extrarenal arterial blood supply of renal malignancy for its interventional therapy. Methods: Routine abdominal aortography and selective questionable feeding arteriography were performed in 141 patients with renal malignancy. The characteristics and formation mechanisms of extrarenal arterial blood supply for renal malignancy were analyzed. Results: Of the 141 patients, extrarenal arterial blood supply of renal malignancy were found in 51 patients and there were 87 branchs. The breakthrough of renal capsule with malignancy were found in those 51 patients. No extrarenal arterial blood supply of renal malignancy was found in 90 patients, including 50 patients with and 40 patients without the renal capsule breakthrough with malignancy. The emerge of extrarenal arterial blood supply of renal malignancy were significantly different (χ 2 =31.64, P<0.01) between the patients with and without the breakthrough of renal capsule with malignancy. The origin of extrarenal arterial blood supply were correlated with the location of the tumor. Conclusions: It is important to determine the origin of the extrarenal arterial blood supply in renal malignancy for its interventional therapy. (authors)

  2. Functional dilatation and medial remodeling of the renal artery in response to chronic increased blood flow.

    Science.gov (United States)

    Roan, Jun-Neng; Yeh, Chin-Yi; Chiu, Wen-Cheng; Lee, Chou-Hwei; Chang, Shih-Wei; Jiangshieh, Ya-Fen; Tsai, Yu-Chuan; Lam, Chen-Fuh

    2011-01-01

    Renal blood flow (RBF) is tightly regulated by several intrinsic pathways in maintaining optimal kidney blood supply. Using a rat model of aortocaval (AC) fistula, we investigated remodeling of the renal artery following prolonged increased blood flow. An AC fistula was created in the infrarenal aorta of anesthetized rats, and changes of blood flow in the renal artery were assessed using an ultrasonic flow probe. Morphological changes and expression of endothelial nitric oxide synthase and matrix metalloproteinase-2 in the remodeled renal artery were analyzed. Blood flow in the renal artery increased immediately after creation of AC fistula, but normal RBF was restored 8 weeks later. The renal artery dilated significantly 8 weeks after operation. Expression of endothelial nitric oxide synthase and matrix metalloproteinase-2 was upregulated shortly after blood flow increase, and returned to baseline levels after 3 weeks. Histological sections showed luminal dilatation with medial thickening and endothelial cell-to-smooth muscle cell attachments in the remodeled renal artery. Increased RBF was accommodated by functional dilatation and remodeling in the medial layer of the renal artery in order to restore normal blood flow. Our results provide important mechanistic insight into the intrinsic regulation of the renal artery in response to increased RBF. Copyright © 2011 S. Karger AG, Basel.

  3. Predictors of diagnostic success with renal artery duplex ultrasonography.

    Science.gov (United States)

    Hedayati, Nasim; Del Pizzo, David J; Harris, Sean E; Kuskowski, Michael; Pevec, William C; Lee, Eugene S; Pifer, Christy; Dawson, David L

    2011-05-01

    Renal artery duplex ultrasonography (RA-DUS) is commonly used for the evaluation and follow-up of renal artery atherosclerotic disease. In a complete study, renal artery flow is evaluated from the vessel origin to the intraparenchymal branches. The quality of RA-DUS is in part technologist-dependent, but many factors may affect the ability to complete a diagnostic examination. This study evaluated the clinical and technical factors that predict the ability to obtain a complete RA-DUS examination. A prospective evaluation of all patients undergoing RA-DUS between July 2008 and February 2009 was performed. Factors such as patient age, gender, body mass index, technologists' years of experience, patient care setting (inpatient vs. outpatient), bedside examination, smoking before the examination, fasting status, and recent abdominal surgery were all recorded. Multivariate logistic regression analysis was performed. A p value of ≤ 0.05 was considered significant. During the study period, 250 patients underwent RA-DUS (mean age: 59.9 ± 17.8 years, 57% [143] female). A total of 87 (35%) examinations were incomplete. This included nondiagnostic examinations which did not exhibit any segment of the renal artery. Factors that were associated with an incomplete examination included technologists' years of experience (OR = 0.92, p = 0.042), bedside examination (OR = 4.17, p = 0.016), and recent abdominal surgery (OR = 3.45, p = 0.047). Body mass index, fasting status, and smoking before the examination did not affect the ability to obtain a complete study. One-third of the RA-DUS studies were classified as incomplete by the strict criteria used in this prospective study. An experienced ultrasound technologist is more likely to obtain a complete RA-DUS examination. Recent abdominal surgery and bedside examinations were predictive of a limited examination as well. Vascular laboratories should consider these factors when scheduling examinations so as to obtain complete RA

  4. Imaging and management of atherosclerotic renal artery stenosis

    International Nuclear Information System (INIS)

    Sarkodieh, J.E.; Walden, S.H.; Low, D.

    2013-01-01

    Renal artery stenosis (RAS) causes chronic, progressive ischaemic nephropathy and is the most common cause of secondary hypertension. Radiology plays a large part in the diagnosis, with a variety of imaging techniques available. Each has relative advantages and disadvantages depending on each unique clinical setting. We discuss and illustrate the range of diagnostic methods and interventional techniques for diagnosis and management of RAS and review the current evidence base for endovascular therapy compared with optimal medical management. Knowledge of the relative merits of the various forms of imaging and treatment will guide decision making in the multidisciplinary setting

  5. Angiographic diagnosis of fibromuscular dysplasia of the renal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Petkov, B.; Grigorov, G.; Nedelkov, G. (Meditsinska Akademiya, Sofia (Bulgaria). Nauchen Inst. po Rentgenologiya i Radiobiologiya)

    1982-01-01

    In the nosological structure of renovascular hypertensions fibromuscular dysplasia of the renal arteries by incidence ranks second after atherosclerosis. The illness affects mainly women, more frequently young and having borne a child. Hypertension in such patients is usually characterized by high values of the diastolic pressure, and leads to early neurologic complaints such as headache, sight impairment, vertigo and Meniere-like syndromes. Morphological and functional changes are likewise described. Some of the literature statements concerning the etiopathogenesis and classification of fibromuscular dysplasia are critically assayed. The success of the surgical management depends on the timely established exact diagnosis, and angiography appears to be the only method of primary importance in this respect.

  6. Multidetector computed tomography of the renal arteries in vascular emergencies

    International Nuclear Information System (INIS)

    Regine, Giovanni; Stasolla, Alessandro; Miele, Vittorio

    2007-01-01

    Multidetector computed tomography (MDCT) has drastically changed the diagnostic imaging protocol in both traumatic and non-traumatic vascular emergencies, replacing almost completely the traditional primary role of catheter angiography. MDCT is a well-established tool for the elective evaluation of stenoses, malformations, and dysplasias in the settings of renovascular hypertension, but probably less used in the settings of acute traumatic and non-traumatic clinical situations. The aim of this review is to define the role of MDCT in renal arteries emergencies

  7. Multi-scale computational model of three-dimensional hemodynamics within a deformable full-body arterial network

    Energy Technology Data Exchange (ETDEWEB)

    Xiao, Nan [Department of Bioengineering, Stanford University, Stanford, CA 94305 (United States); Department of Biomedical Engineering, King’s College London, London SE1 7EH (United Kingdom); Humphrey, Jay D. [Department of Biomedical Engineering, Yale University, New Haven, CT 06520 (United States); Figueroa, C. Alberto, E-mail: alberto.figueroa@kcl.ac.uk [Department of Biomedical Engineering, King’s College London, London SE1 7EH (United Kingdom)

    2013-07-01

    In this article, we present a computational multi-scale model of fully three-dimensional and unsteady hemodynamics within the primary large arteries in the human. Computed tomography image data from two different patients were used to reconstruct a nearly complete network of the major arteries from head to foot. A linearized coupled-momentum method for fluid–structure-interaction was used to describe vessel wall deformability and a multi-domain method for outflow boundary condition specification was used to account for the distal circulation. We demonstrated that physiologically realistic results can be obtained from the model by comparing simulated quantities such as regional blood flow, pressure and flow waveforms, and pulse wave velocities to known values in the literature. We also simulated the impact of age-related arterial stiffening on wave propagation phenomena by progressively increasing the stiffness of the central arteries and found that the predicted effects on pressure amplification and pulse wave velocity are in agreement with findings in the clinical literature. This work demonstrates the feasibility of three-dimensional techniques for simulating hemodynamics in a full-body compliant arterial network.

  8. Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report

    Directory of Open Access Journals (Sweden)

    Parikh Chirag R

    2004-05-01

    Full Text Available Abstract Background Medical management is the conventional treatment for Stanford Type B aortic dissections as surgery is associated with significant morbidity and mortality. The advent of endovascular interventional techniques has revived interest in treating end-organ complications of Type B aortic dissection. We describe a patient who benefited from endovascular repair of renal artery stenosis caused by a dissection flap, which resulted in reversal of his end-stage renal disease (ESRD. Case presentation A 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 μmol/L on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement. Conclusion Percutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population.

  9. Perioperative Hemodynamic Monitoring of Common Hepatic Artery for Endovascular Embolization of a Pancreaticoduodenal Arcade Aneurysm with Celiac Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Shibata, Eisuke, E-mail: eisuke.shibata1130@gmail.com; Takao, Hidemasa; Amemiya, Shiori; Ohtomo, Kuni [The University of Tokyo, Department of Radiology, Graduate School of Medicine (Japan)

    2017-03-15

    This report describes perioperative hemodynamic monitoring of the common hepatic artery (CHA) during endovascular treatment of a pancreaticoduodenal arcade aneurysm, in a patient with celiac artery stenosis caused by the median arcuate ligament. Pressure monitoring was performed as a safety measure against critical complications such as liver ischemia. As the aneurysm was located in the anterior pancreaticoduodenal artery (APDA) and the posterior pancreaticoduodenal artery (PPDA) was small in caliber, the patient was considered to be at a high risk of liver ischemia. No significant change in pressure was observed in the CHA on balloon occlusion test in the APDA. Immediately after embolization, the PPDA enlarged and the pressure in the CHA was well maintained. Pressure monitoring appears to improve patient safety during endovascular treatment of visceral aneurysms.

  10. Perioperative Hemodynamic Monitoring of Common Hepatic Artery for Endovascular Embolization of a Pancreaticoduodenal Arcade Aneurysm with Celiac Stenosis

    International Nuclear Information System (INIS)

    Shibata, Eisuke; Takao, Hidemasa; Amemiya, Shiori; Ohtomo, Kuni

    2017-01-01

    This report describes perioperative hemodynamic monitoring of the common hepatic artery (CHA) during endovascular treatment of a pancreaticoduodenal arcade aneurysm, in a patient with celiac artery stenosis caused by the median arcuate ligament. Pressure monitoring was performed as a safety measure against critical complications such as liver ischemia. As the aneurysm was located in the anterior pancreaticoduodenal artery (APDA) and the posterior pancreaticoduodenal artery (PPDA) was small in caliber, the patient was considered to be at a high risk of liver ischemia. No significant change in pressure was observed in the CHA on balloon occlusion test in the APDA. Immediately after embolization, the PPDA enlarged and the pressure in the CHA was well maintained. Pressure monitoring appears to improve patient safety during endovascular treatment of visceral aneurysms.

  11. Reduction of Blood Pressure Following After Renal Artery Adventitia Stripping During Total Nephroureterectomy: Potential Effect of Renal Sympathetic Denervation.

    Science.gov (United States)

    Okamura, Keisuke; Satou, Shunsuke; Setojima, Keita; Shono, Shinjiro; Miyajima, Shigero; Ishii, Tatsu; Shirai, Kazuyuki; Urata, Hidenori

    2018-05-16

    BACKGROUND Catheter-based renal sympathetic denervation has been reported to be effective for treatment resistance hypertension in Australia and Europe. However, in the blinded SYMPLICITY HTN-3 trial, renal denervation did not achieve a significant decrease in blood pressure (BP) in comparison to sham controls. There have been various discussions on the factors that influenced this result. CASE REPORT Two men on antihypertensive therapy underwent unilateral radical nephroureterectomy for cancer of the renal pelvis. When the renal artery adventitia was stripped and cauterized just before renal artery ligation, the measured BP of the 2 men increased after stripping adventitia and decreased gradually after cauterization of the renal artery. This was presumably due to removal of renal artery sympathetic nerves, similar to the mechanism of catheter-based renal sympathetic denervation, although anesthesia, fluid infusion, and/or mesenteric traction may have had an influence. CONCLUSIONS A similar strategy involving thoracolumbar sympathectomy was reported about 50 years ago. The clinically significant blood pressure reduction in these patients suggests renal denervation is effective.

  12. Comparison of two-dimensional MR angiography and microsphere measurement of renal blood flow for detection of renal artery stenosis

    International Nuclear Information System (INIS)

    Powers, T.A.; Lorenz, C.H.; Shetty, A.N.; Holburn, G.E.; Price, R.R.

    1990-01-01

    This paper compares depiction of the renal arteries by MR angiography to renal blood flow as determined with microspheres in a dog model of renal artery stenosis. A left renal artery stenosis was created by placement of a silk ligature. Nb-95-labeled microspheres were injected into the left ventricle and a reference blood sample was drawn. The dog was imaged in the 1.5-T MR imager with two-dimensional MR angiography sequences. The kidneys were excised, weighted, divided into sections, and counted. Two dogs were studied to date. In dog 1, left renal blood flow (RBF) was 42 mL/min/100 g and right RBF was 337 mL/min/100 g. In dog 2 left RBF was 44 mL/min/100 g and right RBF was 608 mL/min/100 g

  13. Relationship between Renal Artery Stenosis and Severity of Coronary Artery Disease in Patients with Coronary Atherosclerotic Disease

    Directory of Open Access Journals (Sweden)

    Amirfarhang Zandparsa

    2012-09-01

    Full Text Available Objective: The aim of the present investigation was to explore probable association of renal artery stenosis (RAS with coronary artery disease (CAD and the prevalence of renal artery stenosis (RAS in patients with CAD. Patients and methods: This study comprised 165 consecutive patients with CAD, including 52.7% males and 47.2% females with respective mean ages of 60.3 ±8.9 and 59.5±10.1. The patients underwent simultaneous coronary and renal angiographies, and the lumen reduction of 50% or more was considered as significant stenosis. Indeed, stenosis of more than 70% of the arterial lumen was regarded as severe. Results: According to our findings, the prevalence of renal artery stenosis in our hypertensive and normotensive patients were 46.2% and 19.5% respectively (p=0.002. Renal artery angiography revealed that 64 (38.8% of the patients had simultaneous renal artery stenosis. RAS is more common in females than males (p=0.031. Multivariate analysis revealed that among all examined factors, hypertension and serum creatinine were associated with RAS. There was no correlations found between gensini score and RAS (p=0.63. Conclusion: We found a relatively high prevalence of RAS including 46.2% in hypertensive and 19.5% in normotensive patients in our patients with CAD.

  14. Denervation (ablation) of nerve terminalis in renal arteries: early results of interventional treatment of arterial hypertension in Poland.

    Science.gov (United States)

    Bartuś, Krzysztof; Sadowski, Jerzy; Kapelak, Bogusław; Zajdel, Wojciech; Godlewski, Jacek; Bartuś, Stanisław; Bochenek, Maciej; Bartuś, Magdalena; Żmudka, Krzysztof; Sobotka, Paul A

    2013-01-01

    Arterial hypertension is one of the main causes of cardiovascular disease morbidity and overall mortality. To report the single centre experiences with changes in arterial blood pressure (BP) in patients after intra-arterial application of radiofrequency (RF) energy to cause renal sympathetic efferent and somatic afferent nerve and report vascular and kidney safety in a six month follow up. Twenty-eight patients, with hypertension despite medical therapy (median age 52.02 years, range 42-72 years) consented to therapeutic renal nerve ablation. SIMPLICITY RF catheters and generator provided by Ardian (currently Medtronic Inc., USA) were used to perform renal artery angiography and ablation. The mean BP at baseline, and after one month, three months and six months were measured [mm Hg]: systolic 176.6; 162.3 (p = 0.004); 150.6 (p arterial renal nerve denervation was not associated with either vascular or renal complications out to six months. Nerve ablation of renal arteries led to significant reduction of mean values of arterial systolic, diastolic BP and significant reduction of pulse pressure. The Polish experience is not significantly different compared to that reported in the Symplicity I and Symplicity II international cohorts. The long term durability of this therapy and its application to earlier stages of hypertension or other disease states will require further investigation.

  15. Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

    Science.gov (United States)

    Schönherr, Elisabeth; Rehwald, Rafael; Nasseri, Parinaz; Luger, Anna K; Grams, Astrid E; Kerschbaum, Julia; Rehder, Peter; Petersen, Johannes; Glodny, Bernhard

    2016-01-01

    Objective The aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials. Design and setting In a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60±17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies. Results Among the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34±11.4 mm (CI 32 to 36) vs 45.9±15 mm (CI 43.2 to 48.6); p0.05). The first left renal arteries were 1.1±0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3±0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation. Conclusions Based on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates. PMID:26729385

  16. Abdominal Aortic Calcifications Influences the Systemic and Renal Hemodynamic Response to Renal Denervation in the DENERHTN (Renal Denervation for Hypertension) Trial.

    Science.gov (United States)

    Courand, Pierre-Yves; Pereira, Helena; Del Giudice, Costantino; Gosse, Philippe; Monge, Matthieu; Bobrie, Guillaume; Delsart, Pascal; Mounier-Vehier, Claire; Lantelme, Pierre; Denolle, Thierry; Dourmap, Caroline; Halimi, Jean Michel; Girerd, Xavier; Rossignol, Patrick; Zannad, Faiez; Ormezzano, Olivier; Vaisse, Bernard; Herpin, Daniel; Ribstein, Jean; Bouhanick, Beatrice; Mourad, Jean-Jacques; Ferrari, Emile; Chatellier, Gilles; Sapoval, Marc; Azarine, Arshid; Azizi, Michel

    2017-10-10

    The DENERHTN (Renal Denervation for Hypertension) trial confirmed the efficacy of renal denervation (RDN) in lowering daytime ambulatory systolic blood pressure when added to standardized stepped-care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months. This post hoc exploratory analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. In total, 106 patients with resistant hypertension were randomly assigned to RDN plus SSAHT or to the same SSAHT alone (control group). Total AAC volume was measured, with semiautomatic software and blind to randomization, from the aortic hiatus to the iliac bifurcation using the prerandomization noncontrast abdominal computed tomography scans of 90 patients. Measurements were expressed as tertiles. The baseline-adjusted difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the RDN and control groups was -10.1 mm Hg ( P =0.0462) in the lowest tertile and -2.5 mm Hg ( P =0.4987) in the 2 highest tertiles of AAC volume. Estimated glomerular filtration rate remained stable at 6 months for the patients in the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min per 1.73 m 2 ) but decreased in the control group (-8.0 mL/min per 1.73 m 2 , P =0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups ( P =0.2640). RDN plus SSAHT resulted in a larger decrease in daytime ambulatory systolic blood pressure than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in daytime ambulatory systolic blood pressure was not associated with a decrease in estimated glomerular filtration rate. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  17. Renal artery aneurysm in hand-assisted laparoscopic donor nephrectomy: case report.

    Science.gov (United States)

    Maciel, R F; Branco, A J; Branco, A W; Guterres, J C; Silva, A E; Ramos, L B; Rost, C; Vieira, C A; Cicogna, P E S; Daudt, C A; Deboni, L M; Vieira, M A; Luz, H A; Vieira, J A

    2003-12-01

    We report a living donor who underwent laparoscopic nephrectomy using a hand-assisted device (HALD). At preoperative arteriography the donor showed a renal artery aneurysm. The patient was a 37-year-old female, 166 cm height, white, weighing 87 kg, HLA identical to the recipient. HALD was indicated due to the better visualization of renal pedicle and greater security in an obese patient. Renal artery aneurysm is a rare condition, with many possible complications. The method proved to be adequate and safe for donor nephrectomy, despite a renal artery aneurysm.

  18. Endovascular Renal Artery Denervation: Why, When, and How?

    International Nuclear Information System (INIS)

    Sapoval, Marc; Azizi, Michel; Bobrie, Guillaume; Cholley, Bernard; Pagny, Jean-Yves; Plouin, Pierre-François

    2012-01-01

    Endovascular renal artery denervation (ERAD) is a new procedure to reduce renal and systemic sympathetic overactivity in hypertensive patients. The role of sympathetic overactivity is recognized since a long time as being one the contributor of human hypertension. In support of this view, several studies in experimental models of hypertension in animal as well as hypertensive human subjects have demonstrated that sympathetic overactivity plays a central role in hypertension catheter based renal denervation is now possible, and this procedure may provide a useful adjunct for the management of patients with drug-resistant primary hypertension. Following a cohort study, the results of an open label randomized control trial have been published showing very encouraging results. The purpose of this paper is to help interventionalists to better understand the medical and technical issues related to this new intervention. It is most likely that as underlined in a recent editorial several other technical approaches may appear in the future, however because this is the only technique that is available today, we will focus on radiofrequency based technique.

  19. Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study).

    Science.gov (United States)

    Kądziela, Jacek; Januszewicz, Andrzej; Prejbisz, Aleksander; Michałowska, Ilona; Januszewicz, Magdalena; Florczak, Elżbieta; Kalińczuk, Łukasz; Norwa-Otto, Bożena; Warchoł, Ewa; Witkowski, Adam

    2013-01-01

    The aim of our study was to determine a potential relationship between resting translesional pressures ratio (Pd/Pa ratio), renal fractional flow reserve (rFFR) and blood pressure response after renal artery stenting. Thirty five hypertensive patients (49% males, mean age 64 years) with at least 60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were measured before stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before the procedure and after 6 months. The ABPM results were presented as blood pressure changes in subgroups of patients with normal (≥ 0.9) vs. abnormal (renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were comparable in patients with abnormal vs. normal Pd/Pa ratio (-4/-3 vs. 0/2 mm Hg; p = NS) and with abnormal vs. normal rFFR (-2/-1 vs. -2/-0.5 mm Hg, respectively). Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine- induced renal fractional fl ow reserve did not predict hypertension response after renal artery stenting.

  20. Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries

    Science.gov (United States)

    Gulas, Ewelina; Wysiadecki, Grzegorz; Szymański, Jacek; Majos, Agata; Stefańczyk, Ludomir; Topol, Mirosław

    2016-01-01

    Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons. PMID:29593819

  1. Venous digital subtraction angiography of the renal arteries in hypertensive patients

    International Nuclear Information System (INIS)

    Brecht, G.; Harder, T.; Franken, T.

    1984-01-01

    We carried out 1890 venous digital subtraction angiograms; this included 113 patients with hypertension in order to exclude renal artery stenosis. On four occasions it was used following surgery on a renal artery. Renal artery stenosis or occlusion was demonstrated in twelve patients, and other vascular diseases or anomalies were found in 24. Two abnormal renal arteries were found following renal artery surgery. The results are compared with smaller groups of patients examined by DSA, and with the results of conventional subtraction methods reported in the literature. In only eight patients (6.8%) DSA provided insufficient information and had to be supplemented by aortography. The method has proved to be a valuable and simple screening method for the investigation of hypertension. (orig.) [de

  2. Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

    Energy Technology Data Exchange (ETDEWEB)

    Upasani, Anand, E-mail: anand.upasani@gosh.nhs.uk [Great Ormond Street Hospital, Department of Paediatric Urology (United Kingdom); Barnacle, Alex, E-mail: alex.barnacle@gosh.nhs.uk; Roebuck, Derek, E-mail: derek.roebuck@gosh.nhs.uk; Cherian, Abraham, E-mail: abraham.cherian@gosh.nhs.uk [Great Ormond Street Hospital (United Kingdom)

    2017-03-15

    Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

  3. Combination of Surgical Drainage and Renal Artery Embolization: An Alternative Treatment for Xanthogranulomatous Pyelonephritis

    International Nuclear Information System (INIS)

    Upasani, Anand; Barnacle, Alex; Roebuck, Derek; Cherian, Abraham

    2017-01-01

    Conventionally, xanthogranulomatous pyelonephritis is treated with antibiotics and drainage of abscess followed by nephrectomy for definitive treatment. Surgical excision of the affected kidney carries risk of significant complications. An alternative treatment modality is described in the form of embolization of the renal artery to devascularise the renal parenchyma and ablate the renal tissue, thus avoiding a major surgical procedure and the significant risks involved.

  4. Intra-arterial digital subtraction angiography in the diagnosis and treatment of renal tumors

    International Nuclear Information System (INIS)

    Yashiro, Naobumi; Itai, Yuji; Iio, Masahiro

    1985-01-01

    Nine patients with renal tumors were studied by IADSA. Embolization was performed in six patients. IADSA were evaluated on the practical points: vascular mapping, visualization of renal veins, and embolization. Vascular mapping with IADSA was satisfactory in eight patients. The limitation of the field of view was the major restricting factor in two. One with multiple renal arteries was unacceptable. Visualization of renal veins by IADSA with renal artery injections was not reliable because of misregistration. Conventional arteriography with large dose was thought to be preferrable. Embolization with IADSA was satisfactory. Significant reduction of contrast load and procedure time was achieved. (author)

  5. Coarctation of the aorta and renal artery stenosis in tuberous sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Flynn, P M; Robinson, M B; Stapleton, F B; Roy, S III; Koh, G; Tonkin, I L.D.

    1984-07-01

    Among neurocutaneous disorders, coarctation of the abdominal aorta and renal artery stenosis have traditionally been associated with neurofibromatosis. We report a 5-year-old girl who was discovered to have bilateral renal artery stenosis, coarctation of the abdominal aorta, renal cysts and typical skin lesions of tuberous clerosis during the evaluation of asymptomatic hypertension. Renal vascular hypertension has not been reported previously in tuberous sclerosis. We conclude that the tuberous sclerosis complex should be expanded to include vascular malformations and the hypertension should not be assumed to be secondary to renal hamartomata or cysts in patients with tuberous sclerosis.

  6. Coarctation of the aorta and renal artery stenosis in tuberous sclerosis

    International Nuclear Information System (INIS)

    Flynn, P.M.; Robinson, M.B.; Stapleton, F.B.; Roy, S. III; Koh, G.; Tonkin, I.L.D.; Tennessee Univ., Memphis; Tennessee Univ., Memphis; LeBonheur Children's Medical Center, Memphis, TN

    1984-01-01

    Among neurocutaneous disorders, coarctation of the abdominal aorta and renal artery stenosis have traditionally been associated with neurofibromatosis. We report a 5-year-old girl who was discovered to have bilateral renal artery stenosis, coarctation of the abdominal aorta, renal cysts and typical skin lesions of tuberous clerosis during the evaluation of asymptomatic hypertension. Renal vascular hypertension has not been reported previously in tuberous sclerosis. We conclude that the tuberous sclerosis complex should be expanded to include vascular malformations and the hypertension should not be assumed to be secondary to renal hamartomata or cysts in patients with tuberous sclerosis. (orig.)

  7. Development of an Experimental and Digital Cardiovascular Arterial Model for Transient Hemodynamic and Postural Change Studies: "A Preliminary Framework Analysis".

    Science.gov (United States)

    Hewlin, Rodward L; Kizito, John P

    2018-03-01

    The ultimate goal of the present work is to aid in the development of tools to assist in the treatment of cardiovascular disease. Gaining an understanding of hemodynamic parameters for medical implants allow clinicians to have some patient-specific proposals for intervention planning. In the present work an experimental and digital computational fluid dynamics (CFD) arterial model consisting of a number of major arteries (aorta, carotid bifurcation, cranial, femoral, jejunal, and subclavian arteries) were fabricated to study: (1) the effects of local hemodynamics (flow parameters) on global hemodynamics (2) the effects of transition from bedrest to upright position (postural change) on hemodynamics, and (3) diffusion of dye (medical drug diffusion simulation) in the arterial system via experimental and numerical techniques. The experimental and digital arterial models used in the present study are the first 3-D systems reported in literature to incorporate the major arterial vessels that deliver blood from the heart to the cranial and femoral arteries. These models are also the first reported in literature to be used for flow parameter assessment via medical drug delivery and orthostatic postural change studies. The present work addresses the design of the experimental and digital arterial model in addition to the design of measuring tools used to measure hemodynamic parameters. The experimental and digital arterial model analyzed in the present study was developed from patient specific computed tomography angiography (CTA) scans and simplified geometric data. Segments such as the aorta (ascending and descending) and carotid bifurcation arteries of the experimental and digital arterial model was created from online available patient-specific CTA scan data provided by Charite' Clinical and Research Hospital. The cranial and coronary arteries were simplified arterial geometries developed from dimensional specification data used in previous work. For the patient

  8. Diagnosis of renal artery stenosis : spiral CTA vs. IA-DSA

    International Nuclear Information System (INIS)

    Kim, Tae Sung; Chung, Jin Wook; Park, Jae Hyung; Kim, Seung Hyup; Yeon, Kyung Mo; Han, Man Chung

    1996-01-01

    To evaluate the accuracy of spiral CT angiography(CTA) in the demonstration of accessory or multiple renal arteries and renal artery stenosis. We prospectively performed CTA in 50 patients (24 males and 26 females) between nine and 77 years old (mean 39.3) in whom renovascular hypertension was suspected (n=32), or who were potential renal donors (n=18). Within two days of CTA, intraarterial digital subtraction angiography(IA-DSA) was performed. Both spiral CTA and IA-DSA images were blindly compared by two radiologists with respect to the number of accessory renal arteries and the location and severity of renal artery stenosis. The severity of renal arterial stenosis was graded with a five-point scale (grades 0-4). CTA demonstrated 26 of total 27 accessory renal arteries (detection rate=96.5%). For the diagnosis of grade 2-4 stenosis (≥50% stenosis) (n=40 of a total of 127 renal arteries), the sensitivity, specificity, and accuracy of CTA were 90%, 96.5%, and 94.5%, respectively. For the detection of grade 3-4 stenoses (≥75% stenosis) (n=33), the sensitivity, specificity, and accuracy of CTA were 87.9%, 98.9%, and 96.1%, respectively. For the detection of grade 3-4 stenoses in the main renal artery (n=27), the sensitivity, specificity, and accuracy of CTA were 96.3%, 100%, and 99.0%, respectively. Spiral CTA is a reliable and accurate screening modality for the evaluation of renal artery in patients suspected to be suffering from renovascular hypertension, or who are potential renal donors

  9. Chemical denervation of the renal artery with vincristine for the treatment of resistant arterial hypertension: first-in-man application.

    Science.gov (United States)

    Stefanadis, Christodoulos; Toutouzas, Konstantinos; Vlachopoulos, Charalambos; Tsioufis, Costas; Synetos, Andreas; Pietri, Panagiota; Tousoulis, Dimitris; Tsiamis, Eleftherios

    2013-01-01

    Renal artery denervation has recently emerged as a novel therapy for patients with resistant hypertension. Clinical results from renal sympathetic denervation support the safety and efficacy of this method over a period of 18 months. However, several limitations have been reported. Previous studies have shown that chemical denervation by vincristine is safe and effective in an experimental model. We describe the first-in-man application of chemical denervation with vincristine in a 74-year-old male patient with resistant arterial hypertension.

  10. Percutaneous treatment of transplant renal artery stenosis in children.

    Science.gov (United States)

    Repetto, Horacio A; Rodríguez-Rilo, Laila; Mendaro, Esteban; Basso, Laura; Galvez, Hugo; Morrone, Gabriela; Vazquez, Luis A

    2004-12-01

    Percutaneous treatment of renal artery stenosis (RAS) is an accepted procedure and numerous reports have been published. However, experience with its use in RAS in the transplanted kidney in children is scarce. Since 1994 we have diagnosed RAS in seven children with the use of Doppler ultrasonography (US), confirming it with percutaneous angiography (PAG). In six of the seven patients percutaneous transluminal angioplasty (PTA) was performed. In one patient a metallic stent was placed due to the extension of the arterial lesion, and a second stent was placed in another child when a re-stenosis was diagnosed 1 month after the PTA. All patients presented with hypertension (de novo or 30% increase over previous values). After ruling out acute rejection, calcineurin inhibitor toxicity, and urinary obstruction, US was performed and, when an increase in arterial flux velocity was registered, PAG was also performed. Six children showed an increase in serum creatinine (Cr) and proteinuria. Blood pressure decreased after the procedure and Cr returned to previous levels in all children. One of the grafts was lost due to chronic transplant rejection 7 years later. The other children have a functioning kidney. Although this is a small group of patients, the consistently good results and the lack of reported experience prompted us to communicate our preliminary observation.

  11. Evaluation of circulating proteins and hemodynamics towards predicting mortality in children with pulmonary arterial hypertension.

    Directory of Open Access Journals (Sweden)

    Brandie D Wagner

    Full Text Available Although many predictors have been evaluated, a set of strong independent prognostic mortality indicators has not been established in children with pediatric pulmonary arterial hypertension (PAH. The aim of this study was to identify a combination of clinical and molecular predictors of survival in PAH.This single-center, retrospective cohort study was performed from children with PAH between 2001 and 2008 at Children's Hospital Colorado. Blood samples from 83 patients (median age of 8.3 years-old were obtained. We retrospectively analyzed 46 variables, which included 27 circulating proteins, 7 demographic variables and 12 hemodynamic and echocardiographic variables for establishing the best predictors of mortality. A data mining approach was utilized to evaluate predictor variables and to uncover complex data structures while performing variable selection in high dimensional problems.Thirteen children (16% died during follow-up (median; 3.1 years and survival rates from time of sample collection at 1 year, 3 years and 5 years were 95%, 85% and 79%, respectively. A subset of potentially informative predictors were identified, the top four are listed here in order of importance: Tissue inhibitors of metalloproteinases-1 (TIMP-1, apolipoprotein-AI, RV/LV diastolic dimension ratio and age at diagnosis. In univariate analysis, TIMP-1 and apolipoprotein-AI had significant association with survival time (hazard ratio [95% confidence interval]: 1.25 [1.03, 1.51] and 0.70 [0.54-0.90], respectively. Patients grouped by TIMP-1 and apolipoprotein-AI values had significantly different survival risks (p<0.01.Important predictors of mortality were identified from a large number of circulating proteins and clinical markers in this cohort. If confirmed in other populations, measurement of a subset of these predictors could aid in management of pediatric PAH by identifying patients at risk for death. These findings also further support a role for the clinical

  12. Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Lufft, Volkmar; Fels, Lueder M.; Egbeyong-Baiyee, Daniel; Olbricht, Christoph J. [Abteilung Nephrologie, Medizinische Hochschule Hannover (Germany); Hoogestraat-Lufft, Linda; Galanski, Michael [Abteilung Diagnostische Radiologie, Medizinische Hochschule Hannover (Germany)

    2002-04-01

    The aim of this study was to compare renal function between patients with renal angiography and patients with renal angiography and angioplasty (AP) for renal artery stenosis (RAS). Forty-seven patients with suspected RAS were prospectively investigated by digital subtraction angiography (DSA) using non-ionic low osmolar contrast media (CM). In 22 patients RAS was detected and in 16 cases an angioplasty was performed in the same session. The following parameters were determined 1 day prior to and after the DSA, respectively: serum creatinine (S-Crea, {mu}mol/l) and single-shot inulin clearance (In-Cl, ml/min) for the evaluation of renal function; and urine alpha 1-microglobuline (AMG, {mu}g/g Crea) and beta-N-acetyl-glucoseaminidase (beta-NAG, U/g Crea) as markers of tubular toxicity. Serum creatinine was measured additionally 2 days after CM had been injected. In both groups with and without AP 174{+-}65 and 104{+-}56 ml of CM (p<0.0005) were used, respectively. There were no differences with regard to renal function or risk factors for CM nephrotoxicity between both groups. In the group with AP S-Crea and In-Cl (each: mean{+-}SD) did not change significantly (before DSA: 171{+-}158 and 61{+-}24, after DSA: 189{+-}177 and 61{+-}25, respectively), beta-NAG (median) rose from 4 to 14 (p<0.05) and AMG from 8 to 55 (n.s., because of high SD). In the group without AP S-Crea increased from 134{+-}109 to 141{+-}113 (p<0.01), In-Cl dropped from 65{+-}26 to 62{+-}26 (p<0,01), beta NAG (median) rose from 4 to 8 (p=0.01), and AMG from 7 to 10 (n.s.). A rise in baseline S-Crea by more than 25% or 44 {mu}mol/l occurred in 4 and 2 patients in the group with and without AP, respectively. Creatinine increase was reversible in all cases within 7 days. In this study using sensitive methods to detect changes of renal function and tubular toxicity no additional renal function impairment in DSA with angioplasty for RAS compared with DSA alone could be demonstrated. Our data suggest

  13. Angiography for renal artery stenosis: no additional impairment of renal function by angioplasty

    International Nuclear Information System (INIS)

    Lufft, Volkmar; Fels, Lueder M.; Egbeyong-Baiyee, Daniel; Olbricht, Christoph J.; Hoogestraat-Lufft, Linda; Galanski, Michael

    2002-01-01

    The aim of this study was to compare renal function between patients with renal angiography and patients with renal angiography and angioplasty (AP) for renal artery stenosis (RAS). Forty-seven patients with suspected RAS were prospectively investigated by digital subtraction angiography (DSA) using non-ionic low osmolar contrast media (CM). In 22 patients RAS was detected and in 16 cases an angioplasty was performed in the same session. The following parameters were determined 1 day prior to and after the DSA, respectively: serum creatinine (S-Crea, μmol/l) and single-shot inulin clearance (In-Cl, ml/min) for the evaluation of renal function; and urine alpha 1-microglobuline (AMG, μg/g Crea) and beta-N-acetyl-glucoseaminidase (beta-NAG, U/g Crea) as markers of tubular toxicity. Serum creatinine was measured additionally 2 days after CM had been injected. In both groups with and without AP 174±65 and 104±56 ml of CM (p<0.0005) were used, respectively. There were no differences with regard to renal function or risk factors for CM nephrotoxicity between both groups. In the group with AP S-Crea and In-Cl (each: mean±SD) did not change significantly (before DSA: 171±158 and 61±24, after DSA: 189±177 and 61±25, respectively), beta-NAG (median) rose from 4 to 14 (p<0.05) and AMG from 8 to 55 (n.s., because of high SD). In the group without AP S-Crea increased from 134±109 to 141±113 (p<0.01), In-Cl dropped from 65±26 to 62±26 (p<0,01), beta NAG (median) rose from 4 to 8 (p=0.01), and AMG from 7 to 10 (n.s.). A rise in baseline S-Crea by more than 25% or 44 μmol/l occurred in 4 and 2 patients in the group with and without AP, respectively. Creatinine increase was reversible in all cases within 7 days. In this study using sensitive methods to detect changes of renal function and tubular toxicity no additional renal function impairment in DSA with angioplasty for RAS compared with DSA alone could be demonstrated. Our data suggest that AP performed for RAS has

  14. The prevalence and clinical predictors of incidental atherosclerotic renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ozkan, Ugur [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey)], E-mail: radugur@yahoo.com; Oguzkurt, Levent; Tercan, Fahri [Baskent University Faculty of Medicine, Department of Radiology, Adana/Turkey (Turkey); Nursal, Tarik Z. [Baskent University Faculty of Medicine, Department of General Surgery, Ankara/Turkey (Turkey)

    2009-03-15

    Objective: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). Materials and methods: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age {+-} S.D.: 61.5 {+-} 11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis ({>=}60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). Results: Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n = 60) had significant ({>=}60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140 mmHg or diastolic >90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5 {+-} 8.9 years compared with 61 {+-} 11.2 years for patients without RAS (p < 0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p = 0.01). Conclusion: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

  15. The prevalence and clinical predictors of incidental atherosclerotic renal artery stenosis

    International Nuclear Information System (INIS)

    Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri; Nursal, Tarik Z.

    2009-01-01

    Objective: To evaluate the prevalence of incidental renal artery stenosis due to atherosclerosis and associated risk factors in patients with peripheral arterial disease (PAD). Materials and methods: To determine renal artery stenosis, aortofemoropopliteal digital substraction angiographies (DSA) of 629 consecutive patients with PAD were prospectively reviewed. Angiographies were performed as catheter angiography with automated pump injection. Of the patients, 540 were male (86%) and 89 female (14%) (mean age ± S.D.: 61.5 ± 11.1 years). Statistical analysis was performed to determine the association of significant renal artery stenosis (≥60% diameter stenosis) with patient demographics (age, sex, reason for angiography and smoking status), medical history (diabetes mellitus, hypertension and coronary artery disease), laboratory values (blood creatinine, fasting glucose, triglycerides, LDL, HDL and total cholesterol) and distribution of PAD (aortoiliac, femoropopliteal and crural diseases and multisegment involvement). Results: Renal artery disease was found in 33% (207 of 629) of all patients with peripheral arterial disease, and 9.6% of patients (n = 60) had significant (≥60%) renal artery stenosis. Only age and hypertension (blood pressure systolic >140 mmHg or diastolic >90 mmHg) were independent risk factors for significant renal artery stenosis on multivariate analysis. Mean age of patients with RAS was 66.5 ± 8.9 years compared with 61 ± 11.2 years for patients without RAS (p < 0.001). Hypertension was found in 41% of the patients in control group and in 63% of the patients in RAS group (p = 0.01). Conclusion: Incidental renal artery stenosis which can be mild or significant is a relatively common finding among patients with peripheral arterial disease. Advance age and hypertension are closely associated with significant renal artery stenosis.

  16. Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?

    International Nuclear Information System (INIS)

    Rokni Yazdi, Hadi; Faraji, Safoura; Ahmadi, Farokhlegha; Shahmirzae, Reza

    2012-01-01

    Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases. In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question. Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease. The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery. The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital

  17. Normal renal arterial anatomy assessed by multidetector CT angiography: are there differences between men and women?

    Science.gov (United States)

    Turba, Ulku Cenk; Uflacker, Renan; Bozlar, Ugur; Hagspiel, Klaus D

    2009-03-01

    The purpose of this study was to determine renal arterial anatomy and gender differences in adults without renovascular disease using multidetector computed tomography angiography (MDCTA). MDCTA datasets of 399 patients were retrospectively reviewed. Measurements of the aortorenal diameters, the angulation of the renal ostia and pedicles as well as the distance between the origins of the renal arteries were measured. Differences in measurements between genders were tested for statistical significance using analysis of variance (ANOVA) and Pearson's Chi-Square tests. A total of 798 renal arteries were available for analysis in 207 female (mean age = 52.91 years) and 192 male patients (mean age = 53.04 years). Female patients were found to have smaller aortae (at the level of the right renal ostium) and bilateral renal arteries than males (mean aortic diameter M/F = 18.33/15.89 mm, mean right renal artery ostial diameter M/F = 5.06/4.59 mm, mean left ostial renal diameter M/F = 5.14/4.66 mm) (p renal ostia level in relation to the vertebrae and the majority of renal arteries originated at the L1 and L2 levels. The longitudinal distance between right and left renal artery ostia ranged from 0 to 32 mm (mean = 4,6 mm, median = 5mm). The mean anteroposterior orientation of the right renal ostia was M/F = 29.45 degrees/28.20 degrees , and M/F = -7.96 degrees/-11.14 degrees for left renal artery ostia. The mean anteroposterior orientation of the right renal pedicle was M/F = 41.37 degrees/44.34 degrees and M/F = 42.31 degrees/43.95 degrees for the left pedicle. There are some differences in normal renal arterial anatomy between genders. Normal renal arterial information is useful not only for planning and performing of endovascular and laparoscopic urologic procedures, but also for medical device development. Copyright 2009 Wiley-Liss, Inc.

  18. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...

  19. Angiographic diagnosis of fibromuscular dysplasia of the renal arteries

    International Nuclear Information System (INIS)

    Petkov, B.; Grigorov, G.; Nedelkov, G.

    1982-01-01

    In the nosological structure of renovascular hypertensions fibromuscular dysplasia of the renal arteries by incidence ranks second after atherosclerosis. The illness affects mainly women, more frequently young and having borne a child. Hypertension in such patients is usually characterized by high values of the diastolic pressure, and leads to early neurologic complaints such as headache, sight impairment, vertigo and Meniere-like syndromes. Morphological and functional changes are likewise described. Some of the literature statements concerning the etiopathogenesis and classification of fibromuscular dysplasia are critically assayed. The success of the surgical management depends on the timely established exact diagnosis, and angiography appears to be the only method of primary importance in this respect. (author)

  20. Coexistence of pheochromocytoma/praganglioma and renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Vijaya Sarathi

    2012-01-01

    Full Text Available Renal artery stenosis (RAS often coexists with pheochromocytoma (Pheo/paraganglioma (PGL and often alters the management of patients with Pheo/PGL. We have studied the prevalence of RAS in our Pheo/PGL patients. The study included 70 consecutive, histopathologically proven Pheo/PGL patients from a tertiary health care center. In 60 patients, tumors were limited to adrenal glands (54 unilateral and 6 bilateral while other 10 patients had extra-adrenal abdominal tumors. Five patients had RAS with an overall prevalence of 14%. Only two out of 60 patients with Pheo had RAS with a low prevalence of 3.3% while three out of 10 patients with extra-adrenal abdominal PGL had RAS with a prevalence of 30%. To conclude, RAS commonly coexists with Pheo/PGL, more often with extra-adrenal PGL.

  1. Recirculation zone length in renal artery is affected by flow spirality and renal-to-aorta flow ratio.

    Science.gov (United States)

    Javadzadegan, Ashkan; Fulker, David; Barber, Tracie

    2017-07-01

    Haemodynamic perturbations such as flow recirculation zones play a key role in progression and development of renal artery stenosis, which typically originate at the aorta-renal bifurcation. The spiral nature of aortic blood flow, division of aortic blood flow in renal artery as well as the exercise conditions have been shown to alter the haemodynamics in both positive and negative ways. This study focuses on the combinative effects of spiral component of blood flow, renal-to-aorta flow ratio and the exercise conditions on the size and distribution of recirculation zones in renal branches using computational fluid dynamics technique. Our findings show that the recirculation length was longest when the renal-to-aorta flow ratio was smallest. Spiral flow and exercise conditions were found to be effective in reducing the recirculation length in particular in small renal-to-aorta flow ratios. These results support the hypothesis that in renal arteries with small flow ratios where a stenosis is already developed an artificially induced spiral flow within the aorta may decelerate the progression of stenosis and thereby help preserve kidney function.

  2. Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Seyed Mojtaba Marashi

    2015-12-01

    Full Text Available A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG. This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction as gabapentin group or received talc powder as placebo (placebo group. Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety  verbal analog scale (VAS at the pre-induction room in gabapentin and placebo groups were 2 and 4,  respectively that was significantly lower in the former group (P. value =0.04 ; however, regarding median of pain score no difference was observed between them (P. value =0.07. Gabapentin (1200mg given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG.

  3. Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment

    Directory of Open Access Journals (Sweden)

    Umberto Marcello Bracale

    2014-01-01

    Full Text Available The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR of an infrarenal abdominal aortic aneurysm (AAA. A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.

  4. Renal Artery Stenosis in Patients with Resistant Hypertension: Stent It or Not?

    Science.gov (United States)

    Van der Niepen, Patricia; Rossignol, Patrick; Lengelé, Jean-Philippe; Berra, Elena; Sarafidis, Pantelis; Persu, Alexandre

    2017-01-01

    After three large neutral trials in which renal artery revascularization failed to reduce cardiovascular and renal morbidity and mortality, renal artery stenting became a therapeutic taboo. However, this is probably unjustified as these trials have important limitations and excluded patients most likely to benefit from revascularization. In particular, patients with severe hypertension were often excluded and resistant hypertension was either poorly described or not conform to the current definition. Effective pharmacological combination treatment can control blood pressure in most patients with renovascular hypertension. However, it may also induce further renal hypoperfusion and thus accelerate progressive loss of renal tissue. Furthermore, case reports of patients with resistant hypertension showing substantial blood pressure improvement after successful revascularization are published over again. To identify those patients who would definitely respond to renal artery stenting, properly designed randomized clinical trials are definitely needed.

  5. Selective arterial embolization in the management of symptomatic renal angiomyolipomas

    Energy Technology Data Exchange (ETDEWEB)

    Mourikis, Dimitrios; Chatziioannou, Achilles; Antoniou, Aristidis; Kehagias, Dimitrios; Gikas, Dimitrios; Vlahos, Lambros

    1999-12-01

    Current management of renal angiomyolipomas (AMLs) include observation, transcatheter embolization and partial or total nephrectomy. Patients symptoms and size of the lesion are the determinants for the choice of the treatment. In general symptomatic or greater than 8 cm masses require intervention. A retrospective study of five patients presented with symptomatic lesions and treated with selective transcatheter embolization, over a 3 year period was performed in our hospital. A total of eight embolizations were performed, all on an emergency basis due to retroperitoneal bleeding or significant hematuria. Surgical intervention was necessary in one case, due to massive rebleeding on the fourth post-procedural day. Two patients rebled within 6 months and 2 years respectively, and were managed successfully with additional embolization. The remaining two patients are still asymptomatic 26 and 18 months after the successful initial result. Experience with this procedure is reported on with emphasis to the clinical outcome. It is believed that selective arterial embolization should be the standard initial therapy for symptomatic renal AMLs.

  6. Selective arterial embolization in the management of symptomatic renal angiomyolipomas

    International Nuclear Information System (INIS)

    Mourikis, Dimitrios; Chatziioannou, Achilles; Antoniou, Aristidis; Kehagias, Dimitrios; Gikas, Dimitrios; Vlahos, Lambros

    1999-01-01

    Current management of renal angiomyolipomas (AMLs) include observation, transcatheter embolization and partial or total nephrectomy. Patients symptoms and size of the lesion are the determinants for the choice of the treatment. In general symptomatic or greater than 8 cm masses require intervention. A retrospective study of five patients presented with symptomatic lesions and treated with selective transcatheter embolization, over a 3 year period was performed in our hospital. A total of eight embolizations were performed, all on an emergency basis due to retroperitoneal bleeding or significant hematuria. Surgical intervention was necessary in one case, due to massive rebleeding on the fourth post-procedural day. Two patients rebled within 6 months and 2 years respectively, and were managed successfully with additional embolization. The remaining two patients are still asymptomatic 26 and 18 months after the successful initial result. Experience with this procedure is reported on with emphasis to the clinical outcome. It is believed that selective arterial embolization should be the standard initial therapy for symptomatic renal AMLs

  7. Ex vivo repair of renal artery aneurysm associated with surgical treatment of abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kostić Dušan M.

    2004-01-01

    Full Text Available INTRODUCTION Renal artery aneurysms is relatively uncommon with reported incidence ranges from 0.3% to 1%. However, considering all visceral artery aneurysms the percentage of renal artery aneurysms is relatively high between 15-25%. The distal forms of renal artery aneurysms sometimes require "ex vivo" reconstruction and kidney autotransplantation. CASE REPORT A 75-year-old male presented with the right abdominal and back pain. He suffered from a long history of arterial hypertension and chronic renal failure over the last few months (urea blood = 19.8 mmol/l; creatinine = 198 mmol/l. Duplex ultrasonography showed abdominal aortic aneurysm. Subsequent translumbarangiography revealed juxtarenal abdominal aortic aneurysm associated with distal right renal artery aneurysm. The operation was performed under combined thoracic epidural analgesia and general anesthesia using transperitoneal approach. After the laparotomy, the ascending colon was mobilized and reflected medially followed by Kocher maneuver. The result was visualization of the anterior aspect of the right kidney, the collecting system, ureter as well as the right renal vein and artery with large saccular aneurysm located distally. After mobilization of the renal vessels and careful dissection of the ureter, the kidney was explanted. The operation was continued by two surgical teams. The first team performed abdominal aortic aneurysm resection and reconstruction with bifurcated Dacron graft. The second team performed ex vivo reparation of renal artery aneurysm. All time during the explantation, the kidney was perfused by Collins' solution. The saccular right renal artery aneurysm 4 cm in diameter was located at the kidney hilus at the first bifurcation. Three branches originated from the aneurysm. The aneurysm was resected completely. The longest and widest of three branches arising from the aneurysmal sac was end-to-end anastomized with 6 mm PTFE graft. After this intervention, one of

  8. Diabetes insipidus-like state complicating percutaneous transluminal renal stenting for transplant renal artery stenosis.

    Science.gov (United States)

    Tian, Lu; He, Yangyan; Zhang, Hongkun; Wu, Ziheng; Li, Donglin; Chen, Shanwen

    2014-07-01

    To report the incidence, etiology, and treatments of diabetes insipidus-like state that complicate percutaneous transluminal renal stenting (PTRS) for transplant renal artery stenosis (TRAS). Data from 7 patients on whom PTRS for TRAS was performed between October 2008 and March 2012 were reviewed retrospectively. The parameters investigated included blood flow velocity, blood pressure, and creatinine levels before and after the intervention. The procedural success rate was 100%. Three cases developed a diabetes insipidus-like state in the immediate postprocedural period. Urine output returned to normal within 2 weeks after treatment. The median blood flow velocity was significantly reduced from 4.51 m/sec (4.31-4.61 m/sec) at the time of TRAS diagnosis to 1.33 m/sec (1.31-1.51 m/sec) at the most recent follow-up of the group with a diabetes insipidus-like state. The ratio of median blood flow velocity before and after stenting in the group with a diabetes insipidus-like state was significantly higher than that in the group without a diabetes insipidus-like state (3.39 vs. 1.93). Diabetes insipidus-like state that complicates PTRS for TRAS is not an uncommon event, but appears to be underreported in the medical literature. A high ratio of pre- and poststenting median blood flow velocity may be a predictor for a postprocedural diabetes insipidus-like state. The most probable cause may be the marked increase in renal arterial flow. Early recognition of the condition is essential to avoid dehydration and electrolyte imbalance. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. A Rare Case of Atypical Renal Arteries Arrangement with Ectopic Kidneys in a Guinea Pig

    Directory of Open Access Journals (Sweden)

    Maženský D.

    2016-12-01

    Full Text Available We recorded a very rare case of atypical renal arteries arrangement in a guinea pig using the corrosion technique in the study of the arterial system. The right renal artery originated from the ventral wall of the abdominal aorta at the level of the caudal aspect of the 5th lumbar vertebra. The left renal artery originated from the left common iliac artery approximately 12 mm caudally to the aortic bifurcation. The right kidney was located ventral to the aortic bifurcation and the left kidney inside the pelvic cavity between the common iliac arteries. According to the vascular pattern, we determined that the ectopic kidneys in this guinea pig were unusual. This is the first case describing bilateral ectopic kidneys in a guinea pig.

  10. Is the antiproteinuric effect of dipyridamole hemodynamically mediated

    NARCIS (Netherlands)

    de Jong, P. E.; van der Meer, J.; van der Hem, G. K.; de Zeeuw, D.

    1988-01-01

    We studied the acute antiproteinuric and renal hemodynamic effect of dipyridamole 30–60 mg intravenously in 13 salt-depleted patients with the nephrotic syndrome of different etiology. Whereas mean arterial pressure did not change, a small fall in glomerular filtration rate with a concomitant fall

  11. Variable-viscosity thermal hemodynamic slip flow conveying nanoparticles through a permeable-walled composite stenosed artery

    Science.gov (United States)

    Akbar, Noreen Sher; Tripathi, Dharmendra; Bég, O. Anwar

    2017-07-01

    This paper presents a mathematical model for simulating viscous, incompressible, steady-state blood flow containing copper nanoparticles and coupled heat transfer through a composite stenosed artery with permeable walls. Wall slip hydrodynamic and also thermal buoyancy effects are included. The artery is simulated as an isotropic elastic tube, following Joshi et al. (2009), and a variable viscosity formulation is employed for the flowing blood. The equations governing the transport phenomena are non-dimensionalized and the resulting boundary value problem is solved analytically in the steady state subject to physically appropriate boundary conditions. Numerical computations are conducted to quantify the effects of relevant hemodynamic, thermophysical and nanoscale parameters emerging in the model on velocity and temperature profiles, wall shear stress, impedance resistance and also streamline distributions. The model may be applicable to drug fate transport modeling with nanoparticle agents and also to the optimized design of nanoscale medical devices for diagnosing stenotic diseases in circulatory systems.

  12. Clinical observation of intraluminal stent angioplasty in the treatment of renal arterial stenoses

    International Nuclear Information System (INIS)

    Lu Yanwen; Zhang Jian; Huang Xianglong

    2002-01-01

    Objective: To evaluate the clinical application of intraluminal stent angioplasty (PTRAS) in the treatment of renal arterial stenoses. Methods: A retrospective study was done in 28 patients with renal arterial stenoses. Primary renal artery stenting was performed in 28 consecutive patients (36 renal arteries). Blood pressure, serum creating, the number of anti-hypertensive medications were recorded at 1, 6, 12 month post stent angioplasty respectively. Arterial angiography was also taken 1 year later to evaluate the incidence of restenosis. Results: Technical success rate was 100% achieving in all patients without serious complications. Primary successful patently rate reached 82% (renal artery 86%), secondary successful rate was 89% (renal artery 90%). Systolic and diastolic blood pressure were reduced significantly (P<0.01) at 1,6,12 month after stent angioplasty comparing with baseline and clinical improvement (cured + improved) of hypertension reached 100%, 92.9%, 89.3% respectively. There were no significant differences between serum creatine level and the number of anti-hypertensive medications before and after stent angioplasty. One year later, 14.3% of all patients showed improvement of renal function, 64.3% remained in stabilization and 21.4% fell into deterioration. Angiographic restenosis was found in 3 cases one year after stent angioplasty. Complications included 1 hematoma at puncture site and 3 transient azotaemia. Conclusions: PTRAS can be performed safely with high technical success and beneficial to the majority of patients with hypertension or renal insufficiency and therefore it should be the first choice in treating renal arterial stenoses

  13. Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation

    International Nuclear Information System (INIS)

    Beregi, J.P.; Willoteaux, S.; Remy-Jardin, M.; Mauroy, B.; Francke, J.P.; Mounier-Vehier, C.

    1999-01-01

    The aim of this study was to provide quantitative data on the origin and trajectory of the main renal arteries using spiral CT angiography and arteriography. Normal renal artery anatomy was assessed on spiral CT angiography (axial transverse sections and shaded-surface-display reconstructions) in 100 patients referred for renal arteriography who had no significant renal artery stenosis. Two hundred major renal arteries were studied. The vast majority of right (88 %) and left (87 %) renal arteries originated between the lower third of the first lumbar vertebra and the lower border of the second lumbar vertebra. In 50 patients both ostia were at the same level; in the remaining 50 patients, the right ostium was located above the left in 37 patients. On the right, the angle of origin varied from -10 to + 55 (mean + 24 ). On the left, the angle of origin varied from + 30 to -55 (mean -11 ). Spiral CT angiography provides additional anatomic data, notably regarding the angle of origin of the renal arteries, that is potentially useful for planning interventional procedures. (orig.)

  14. Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Beregi, J.P.; Willoteaux, S.; Remy-Jardin, M. [Department of Vascular Radiology, Hopital Cardiologique, 59 - Lille (France); Mauroy, B.; Francke, J.P. [Laboratoire d`Anatomie, Univ. de Lille (France); Mounier-Vehier, C. [Department of Hypertension and Internal Medicine, Hopital Cardiologique, Lille (France)

    1999-09-01

    The aim of this study was to provide quantitative data on the origin and trajectory of the main renal arteries using spiral CT angiography and arteriography. Normal renal artery anatomy was assessed on spiral CT angiography (axial transverse sections and shaded-surface-display reconstructions) in 100 patients referred for renal arteriography who had no significant renal artery stenosis. Two hundred major renal arteries were studied. The vast majority of right (88 %) and left (87 %) renal arteries originated between the lower third of the first lumbar vertebra and the lower border of the second lumbar vertebra. In 50 patients both ostia were at the same level; in the remaining 50 patients, the right ostium was located above the left in 37 patients. On the right, the angle of origin varied from -10 to + 55 (mean + 24 ). On the left, the angle of origin varied from + 30 to -55 (mean -11 ). Spiral CT angiography provides additional anatomic data, notably regarding the angle of origin of the renal arteries, that is potentially useful for planning interventional procedures. (orig.) With 4 figs., 19 refs.

  15. When stenting in renal artery stenosis? Update on pathophysiology of ischemic nephropathy and management strategies

    Directory of Open Access Journals (Sweden)

    Alessandro Zuccalà

    2013-11-01

    Full Text Available In recent years, decisions taken on the optimal management of patients with renal artery stenosis have triggered off controversy and debate among clinicians dealing with renovascular disease. The main reason underlying this ongoing controversy may be the heterogeneity of the clinical entities that are normally associated with the umbrella definition of renal artery stenosis. Indeed a causal link between the stenosis and its clinical consequences (i.e. hypertension, renal failure can often demonstrated in some entities, such as fibromuscular dysplasia, truncal stenosis or arterial stenosis in the transplanted kidney, which can be defined as pure renal artery stenosis. On the contrary, the entity generally called ostial stenosis is a disease of the abdominal aorta where it encroaches the ostium of the renal artery at the end of a long process involving the entire vascular tree. Patients affected by ostial stenosis also suffer from generalized atherosclerosis, and kidney damage is often caused by the atherosclerotic environment with the stenosis acting as an innocent bystander. This may account for the low rate of renal function recovery in subjects with ostial stenosis. In our view, keeping the different entities separate along with a careful understanding of the mechanisms underpinning renal damage, particularly the intrarenal activation of the renin angiotensin system which in turn induces renal inflammation and oxidative stress, may enable clinicians to make the right decisions in regard to revascularization.

  16. Beneficial Effects of Renal Denervation on Pulmonary Vascular Remodeling in Experimental Pulmonary Artery Hypertension.

    Science.gov (United States)

    Qingyan, Zhao; Xuejun, Jiang; Yanhong, Tang; Zixuan, Dai; Xiaozhan, Wang; Xule, Wang; Zongwen, Guo; Wei, Hu; Shengbo, Yu; Congxin, Huang

    2015-07-01

    Activation of both the sympathetic nervous system and the renin-angiotensin-aldosterone system is closely associated with pulmonary arterial hypertension. We hypothesized that renal denervation decreases renin-angiotensin-aldosterone activity and inhibits the progression of pulmonary arterial hypertension. Twenty-two beagles were randomized into 3 groups. The dogs' pulmonary dynamics were measured before and 8 weeks after injection of 0.1mL/kg dimethylformamide (control dogs) or 2mg/kg dehydromonocrotaline (pulmonary arterial hypertension and pulmonary arterial hypertension + renal denervation dogs). Eight weeks after injection, neurohormone levels and pulmonary tissue morphology were measured. Levels of plasma angiotensin II and endothelin-1 were significantly increased after 8 weeks in the pulmonary arterial hypertension dogs and were higher in the lung tissues of these dogs than in those of the control and renal denervation dogs (mean [standard deviation] angiotensin II: 65 [9.8] vs 38 [6.7], 46 [8.1]; endothelin-1: 96 [10.3] vs 54 [6.2], 67 [9.4]; P < .01). Dehydromonocrotaline increased the mean pulmonary arterial pressure (16 [3.4] mmHg vs 33 [7.3] mmHg; P < .01), and renal denervation prevented this increase. Pulmonary smooth muscle cell proliferation was higher in the pulmonary arterial hypertension dogs than in the control and pulmonary arterial hypertension + renal denervation dogs. Renal denervation attenuates pulmonary vascular remodeling and decreases pulmonary arterial pressure in experimental pulmonary arterial hypertension. The effect of renal denervation may contribute to decreased neurohormone levels. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Down-regulation of integrin β1 and focal adhesion kinase in renal glomeruli under various hemodynamic conditions.

    Directory of Open Access Journals (Sweden)

    Xiaoli Yuan

    Full Text Available Given that integrin β1 is an important component of the connection to maintain glomerular structural integrity, by binding with multiple extracellular matrix proteins and mediating intracellular signaling. Focal adhesion kinase (FAK is the most essential intracellular integrator in the integrin β1-FAK signalling pathway. Here, we investigated the changes of the two molecules and visualized the possible interaction between them under various hemodynamic conditions in podocytes. Mice kidney tissues were prepared using in vivo cryotechnique (IVCT and then were stained and observed using light microscopy, confocal laser scanning microscopy and immunoelectron microscopy. The expression of these molecules were examined by western blot. Under the normal condition, integrin β1 stained continually and evenly at the membrane, and FAK was located in the cytoplasm and nuclei of the podocytes. There were significant colocalized plaques of two molecules. But under acute hypertensive and cardiac arrest conditions, integrin β1 decreased and stained intermittently. Similarly, FAK decreased and appeared uneven. Additionally, FAK translocated to the nuclei of the podocytes. As a result, the colocalization of integrin β1 and FAK reduced obviously under these conditions. Western blot assay showed a consistent result with the immunostaining. Collectively, the abnormal redistribution and decreased expressions of integrin β1 and FAK are important molecular events in regulating the functions of podocytes under abnormal hemodynamic conditions. IVCT could offer considerable advantages for morphological analysis when researching renal diseases.

  18. Evaluation of the renal blood flow by densitometry using cine-angiograms

    International Nuclear Information System (INIS)

    Nikolaev, G.G.; Slobodzyan, B.M.; Mikhajlov, V.A.

    1983-01-01

    A method of the quantitative determination of the blood flow in the renal artery and the arterial bed of the renal parenchyma was developed basing on roentgenocinematography and subsequent densitometric analysis of a roentgenocinefilm. Advantages of the utilization of this method are considered with reference to two groups of patients with chronic pyelonephritis and hypertension without change of a vascular pattern on the angiograms. They are associated with a possibility of separate determination of the hemodynamics on topographycatly Definite zones of the renal arterial bed and hemodynamic disturbances in morphological changes of the renal vessels that are invisible on the angiogra

  19. Comparison of Brain Natriuretic Peptide Levels to Simultaneously Obtained Right Heart Hemodynamics in Stable Outpatients with Pulmonary Arterial Hypertension.

    Science.gov (United States)

    Helgeson, Scott A; Imam, J Saadi; Moss, John E; Hodge, David O; Burger, Charles D

    2018-05-01

    Pulmonary arterial hypertension (PAH) is a progressive disease that requires validated biomarkers of disease severity. While PAH is defined hemodynamically by right heart catheterization (RHC), brain natriuretic peptide (BNP) is recommended by guidelines to assess disease status. Retrospectively collected data in 138 group 1 PAH patients were examined for the correlation of BNP levels to simultaneously obtained right heart catheterization (RHC). Patients were mostly Caucasian women, with functional class III symptoms, mean BNP of 406 ± 443 pg/mL, and an average right atrial pressure (RAP) of 9.9 ± 5.7 mm Hg and mean pulmonary artery pressure (mPAP) of 47.3 ± 14.7 mm Hg. Significant correlation was demonstrated between BNP and RAP ( p = 0.021) and mPAP ( p = 0.003). Additional correlation was seen with right heart size on echocardiography: right atrial (RAE; p = 0.04) and right ventricular enlargement ( p = 0.03). An increased BNP level was an independent predictor of mortality ( p right heart hemodynamics. The current results reinforce the use of BNP level as a continuous variable to assess disease severity in group 1 PAH.

  20. Development of chronic heart failure in a young woman with hypertension associated with renal artery stenosis with preserved renal function

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat

    2014-01-01

    A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated-glomerular fil......A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated......-glomerular filtration rate as well as urine test for protein were all normal. The patient had no peripheral oedema. The transthoracic echocardiography confirmed systolic and diastolic dysfunction and an ejection fraction of 25% and left ventricular hypertrophy. Ultrasound of renal arteries and renal CT angiography...... (renal CTA) revealed a significant stenosis and an aneurysm corresponding to the right renal artery with challenges to traditional interventions....

  1. Clinical role of non-contrast magnetic resonance angiography for evaluation of renal artery stenosis

    International Nuclear Information System (INIS)

    Utsunomiya, Daisuke; Nomitsu, Yohei; Komeda, Yosuke; Okigawa, Takashi; Urata, Joji; Miyazaki, Mitsue; Yamashita, Yasuyuki

    2008-01-01

    The association between a gadolinium-based contrast material and nephrogenic systemic fibrosis has been discussed. The purpose of our study was to evaluate whether non-contrast enhanced magnetic resonance angiography (MRA) might provide sufficient information of renal artery stenosis. The non-contrast MRA of 26 patients with hypertension was retrospectively reviewed in the present study. The significant renal artery stenosis was visually evaluated by comparing non-contrast MRA with computed tomography or conventional angiographic finding. Difference of the intensities between the proximal and distal aorta was quantitatively evaluated. The sensitivity, specificity, positive predictive value and negative predictive value of non-contrast MRA in the evaluation of the renal artery stenosis was 78%, 91%, 64% and 96%, respectively. The distal abdominal aorta showed less signal intensity than the proximal aorta by 16.9±12.2%. Non-contrast MRA is a non-invasive and effective method that allows evaluation of the renal artery stenosis. (author)

  2. Helical CT angiography of renal arteries: two-years of experience

    International Nuclear Information System (INIS)

    Beregi, J.P.; Louvegny, S.; Ceugnart, L.; Willoteaux, S.; Elkohen, M.; Desmoucelle, F.; Deklunder, G.; Wattinne, L.

    1997-01-01

    To evaluate the role of helical CT angiography (CTA) in the detection of renal artery stenosis in hypertensive patients. We studied 300 hypertensive patients (50 prospectively and 250 consecutively) with CTA and arteriography (n = 118). Helical acquisition (collimation 3 mm; pitch = 1, 20 seconds acquisition time) was performed 20-45 seconds after contrast injection (300 mgl/ml; 120 ml, 4 ml/sec. Transverse axial views and 3D reconstructions were analysed (360 deg interpolation algorithm, 1 mm overlapped). In the prospective series, CTA sensibility was 100 % for main renal artery stenoses and specificity was 98.2 %; however 7/32 renal accessory arteries were not visualized. In the 300 patients studies, seventy-four stenoses were detected. There were 5 false-positive and 5 false-negative studies. Secondary hypertension was detected in 26 % of patients (including 14 cases of adrenal hyperplasia). CTA is a promising technique for the detection of renal artery stenosis in hypertensive patients. (authors)

  3. Cost analysis of procedures related to the management of renal artery stenosis from various perspectives

    International Nuclear Information System (INIS)

    Helvoort-Postulart, Debby van; Dirksen, Carmen D.; Kessels, Alfons G.H.; Kroon, Abraham A.; Leeuw, Peter W. de; Nelemans, Patricia J.; Engelshoven, Jos M.A. van; Myriam Hunink, M.G.

    2006-01-01

    To determine the costs associated with the diagnostic work-up and percutaneous revascularization of renal artery stenosis from various perspectives. A prospective multicenter comparative study was conducted between 1998 and 2001. A total of 402 hypertensive patients with suspected renal artery stenosis were included. Costs were assessed of computed tomography angiography (CTA), magnetic resonance angiography (MRA), digital subtraction angiography (DSA), and percutaneous revascularization. From the societal perspective, DSA was the most costly (EUR 1,721) and CTA the least costly diagnostic technique (EUR 424). CTA was the least costly imaging procedure irrespective of the perspective used. The societal costs associated with percutaneous renal artery revascularization ranged from EUR 2,680 to EUR 6,172. Overall the radiology department incurred the largest proportion of the total societal costs. For the management of renal artery stenosis, performing the analysis from different perspectives leads to the same conclusion concerning the least costly diagnostic imaging and revascularization procedure. (orig.)

  4. Value of contrast-enhanced 3D MR angiography of the renal arteries

    International Nuclear Information System (INIS)

    Hany, T.F.; Pfammatter, T.; Schmidt, M.; Leung, D.A.; Debatin, J.F.

    1997-01-01

    Purpose: To determine the value of gadolinium-enhanced, three-dimensional breath-hold Magnetic Resonance Angiography (MRA) in the assessment of the aorta and renal arteries in comparison to conventional arteriography (CA). Patients and methods: 49 patients were evaluated with both CA and 3D MRA. 0.3 mmol/kg BW gadolinium-DTPA was administered intravenously in a bolus, using an automated injector. A test bolus method was used for timing of the bolus and beginning of the data acquisition. The intraaterial CA was used as the gold standard. Results: MRA-based assessment of renal artery stenosis was identical with CA in 31 of 45 stenoses (68.8%). Senstivity and specificity for assessment of renal arterial disease by MRA were 84% and 96%; for clinically relevant lesions they amounted to 90% and 98%. Conclusion: The presented contrast-enhanced 3D MRA technique allows for the reliable assessment of renal arterial morphology and pathology. (orig.) [de

  5. An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon

    Directory of Open Access Journals (Sweden)

    Devendra A. Sawant

    2015-01-01

    Full Text Available Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder.

  6. Severe Malignant Hypertension following Renal Artery Embolization: A Crucial Role for the Renal Microcirculation in the Pathogenesis of Hypertension?

    OpenAIRE

    Khan, N; Jeans, J; Mahdi, S; Belli, AM; Antonios, TFT

    2017-01-01

    Malignant hypertension is the most severe form of hypertension that is usually fatal if not properly managed. It is usually associated with evidence of microvascular damage such as retinopathy and nephropathy. Renal artery embolization is a widely utilised tool for the management of a wide range of conditions including drug resistant renovascular hypertension in patients with end stage renal failure. In this report we describe two patients with mild-to-moderate hypertension who underwent rena...

  7. Evaluation of Blood Hemodynamics in Vascular Grafts after Total Arterial Coronary Revascularization

    Directory of Open Access Journals (Sweden)

    Ahmad Ali Amirghofran

    2016-07-01

    Full Text Available Arterial grafting has increasingly been advocated for the treatment of coronary artery disease in an attempt to improve the long-term results. In the quest to perform routine total arterial revascularization, composite Y graft methods are gaining popularity. The aim of our study was to evaluate whether blood flow in the left internal thoracic artery can provide sufficient perfusion to the entire cardiac muscle per se. Twenty patients with severe coronary artery stenosis who underwent complete arterial coronary revascularization using a composite graft entered our study. Blood flow in thoracic trunk was evaluated in three phases: cross-clamp on, cross-clamp off, and after weaning the patient from cardiopulmonary bypass. Mean arterial blood pressure in the thoracic trunk in these various positions was 62.7±3.7. left internal thora cic artery can provide sufficient blood flow to the cardiac muscles for both rest and exercise conditions.

  8. Flash pulmonary edema in patients with renal artery stenosis--the Pickering Syndrome

    DEFF Research Database (Denmark)

    Pelta, Anna; Andersen, Ulrik B; Just, Sven

    2010-01-01

    We report the prevalence of flash pulmonary edema in patients consecutively referred for balloon angioplasty of uni- or bilateral renal artery stenosis (PTRA), and describe the characteristics of this special fraction of the patients. We further report two unusual cases.......We report the prevalence of flash pulmonary edema in patients consecutively referred for balloon angioplasty of uni- or bilateral renal artery stenosis (PTRA), and describe the characteristics of this special fraction of the patients. We further report two unusual cases....

  9. Drug-interaction-induced hemodynamically mediated acute renal failure in postsurgical patient

    Directory of Open Access Journals (Sweden)

    Arup K Misra

    2014-01-01

    Full Text Available Acute renal failure is a life threatening condition. Nonsteroidal antiinflammatory drugs (NSAIDs and cephalosporins are widely used postoperative drugs. NSAID-induced acute renal failure has been reported in the past. In this case, drug interaction and decompensated state of the patient precipitate the condition. NSAIDs inhibit prostaglandins synthesis and thus aggravate ischemia to the kidney that is already facing volume crisis due to surgery. Due to renal dysfunction, plasma ceftriaxone level increases due to decrease clearance and it also acts as nephrotoxic by unknown mechanism. On the other hand, ceftriaxone on its interaction with diclofenac for renal tubular clearance also increases the level of diclofenac and thus further aggravate the ischemia. It is a reversible condition with excluding diclofenac from the treatment regimen and giving adequate hydration to the patient. This highlights the importance of hydration and knowledge of drugs interactions in a postsurgical patient.

  10. MR velocity mapping measurement of renal artery blood flow in patients with impaired kidney function

    DEFF Research Database (Denmark)

    Cortsen, M; Petersen, L.J.; Stahlberg, F

    1996-01-01

    Renal blood flow (RBF) was measured in 9 patients with chronic impaired kidney function using MR velocity mapping and compared to PAH clearance and 99mTc-DTPA scintigraphy. An image plane suitable for flow measurement perpendicular to the renal arteries was chosen from 2-dimensional MR angiography....... MR velocity mapping was performed in both renal arteries using an ECG-triggered gradient echo pulse sequence previously validated in normal volunteers. Effective renal plasma flow was calculated from the clearance rate of PAH during constant infusion and the split of renal function was evaluated...... by 99mTc-DTPA scintigraphy. A reduction of RBF was found, and there was a significant correlation between PAH clearance multiplied by 1/(1-hematocrit) and RBF determined by MR velocity mapping. Furthermore, a significant correlation between the distribution of renal function and the percent distribution...

  11. Anatomical Comparison of the Renal Arteries in the Rabbit and European Hare

    Directory of Open Access Journals (Sweden)

    Flešárová S.

    2017-12-01

    Full Text Available The aim of this paper was to compare the level of origin of the renal arteries in the rabbit and hare. The study was carried out on ten adult rabbits and ten adult European hares using the corrosion cast technique. After the euthanasia, the vascular network was perfused with saline. Batson’s corrosion casting kit No. 17 was used as a casting medium. After polymerization of the medium, the maceration was carried out in KOH solution. We found variable levels of the origin of renal arteries in the rabbit, in the hare and between both species. In the rabbit, the right renal artery originated at the level of the second lumbar vertebra in 70 % of the cases and at the level of the first lumbar vertebra in 30 % of the cases, and the left-sided renal artery originated in 60 % of the cases at the level of the second lumbar vertebra and at the level of the third lumbar vertebra in 40 % of the cases. In the hare, the bilateral renal arteries originated at the level of the second lumbar vertebra. According to the results, it can be concluded that the origin level of the renal arteries from the abdominal aorta is more variable in the domesticated rabbit in comparison with the hare.

  12. Renal artery blood flow assessed by video dilution technique before and after percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Lantz, B.M.T.; Link, D.P.; Lewis, E.L.; Foerster, J.M.; Lee, G.

    1981-01-01

    Successful percutaneous transluminal angioplasty was performed in 3 cases of renal artery stenosis where the effect upon renal blood flow was quantified by video dilution technique. This technique adds important information to pressure gradients and renin assays obtained during the dilatation procedure. (Auth.)

  13. Unilateral renal artery stenosis and hypertension. II. Angiographic findings correlated with blood pressure response after surgery

    Energy Technology Data Exchange (ETDEWEB)

    Andersson, I; Bergentz, S E; Ericsson, B F; Dymling, J F; Hansson, B G; Hoekfelt, B [Department of Diagnostic Radiography, Surgery and Endocrinology, Malmoe Allmaenna Sjukhus, Malmoe, Sweden

    1979-01-01

    The findings at preoperative nephroanigiography of 42 hypertensive patients with unilateral renal artery stenosis or occlusion were correlated with the blood pressure response following surgery and also with the preoperative renal vein renin activity ratio. A stenosis reducing luminal area by at least 90 per cent (or occlusion) and the presence of collateral circulation are considered to be highly suggestive of renovascular hypertension.

  14. Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries.

    Science.gov (United States)

    Majos, Marcin; Stefańczyk, Ludomir; Szemraj-Rogucka, Zofia; Elgalal, Marcin; De Caro, Raffaele; Macchi, Veronica; Polguj, Michał

    2018-04-01

    An in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries. Computed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply. The frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219). The classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.

  15. Denervation of nerve terminals in renal arteries: one-year follow-up of interventional treatment of arterial hypertension.

    Science.gov (United States)

    Bartuś, Krzysztof; Sadowski, Jerzy; Kapelak, Bogusław; Litwinowicz, Radosław; Zajdel, Wojciech; Godlewski, Jacek; Bartuś, Magdalena; Zmudka, Krzysztof; Chrapusta, Anna; Konstanty-Kalandyk, Janusz; Węgrzyn, Piotr; Sobotka, Paul A

    2014-01-01

    Arterial hypertension is the most common cardiovascular system disease, affecting nearly one billion people worldwide. Despite the widespread use of antihypertensive medications, in some groups of patients an optimal blood pressure (BP) cannot be achieved. To assess BP reduction in patients with resistant hypertension after a catheter-based renal sympathetic denervation procedure and to report vascular and kidney safety in one-year follow-up. Twenty eight patients with diagnosed resistant hypertension (median age 52.02 years, range 42-72) underwent percutaneous catheter-based renal denervation of nerve terminals in renal arteries. Arterial angiography and procedure of ablation was performed by Symplicity catheters and generator provided by Ardian (currently Medtronic Inc., USA). Mean BP value before ablation was [mm Hg]: systolic 176.6, diastolic 100.28 and pulse pressure 73.4. After the procedure, reductions in the value of BP were reported [mm Hg]: systolic 154.8/152.54; diastolic 90.2/89.8, pulse pressure 64.66/62.73, respectively in nine-month and one-year follow-up. All results were statistically significant. No complications during one year observation were observed. Percutaneous renal artery ablation procedure effectively reduces systolic BP, diastolic BP, and pulse pressure. No vascular or renal complications in any of the patients were observed. The results of a Polish research group showed no significant differences compared to the results obtained in the international studies Symplicity I and Symplicity II.

  16. Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Pedrosa, Ivan [Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Radiology, Boston, MA (United States); UT Southwestern Medical Center, Department of Radiology, Dallas, TX (United States); Rafatzand, Khashayar; Robson, Philip; Alsop, David C. [Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Radiology, Boston, MA (United States); Wagner, Andrew A. [Beth Israel Deaconess Medical Center and Harvard Medical School, Surgery, Division of Urology, Boston, MA (United States); Atkins, Michael B. [Beth Israel Deaconess Medical Center and Harvard Medical School, Hematology/Oncology, Boston, MA (United States); Rofsky, Neil M. [University of Texas Southwestern Medical Center, Departments of Radiology, Dallas, TX (United States)

    2012-02-15

    To retrospectively evaluate the feasibility of arterial spin labeling (ASL) magnetic resonance imaging (MRI) for the assessment of vascularity of renal masses in patients with impaired renal function. Between May 2007 and November 2008, 11/67 consecutive patients referred for MRI evaluation of a renal mass underwent unenhanced ASL-MRI due to moderate-to-severe chronic or acute renal failure. Mean blood flow in vascularised and non-vascularised lesions and the relation between blood flow and final diagnosis of malignancy were correlated with a 2-sided homogeneous variance t-test and the Fisher Exact Test, respectively. A p value <0.05 was considered statistically significant. Seventeen renal lesions were evaluated in 11 patients (8 male; mean age = 70 years) (range 57-86). The median eGFR was 24 mL/min/1.73 m{sup 2} (range 7-39). The average blood flow of 11 renal masses interpreted as ASL-positive (134 +/- 85.7 mL/100 g/min) was higher than that of 6 renal masses interpreted as ASL-negative (20.5 +/- 8.1 mL/100 g/min)(p = 0.015). ASL-positivity correlated with malignancy (n = 3) or epithelial atypia (n = 1) at histopathology or progression at follow up (n = 7). ASL detection of vascularity in renal masses in patients with impaired renal function is feasible and seems to indicate neoplasia although the technique requires further evaluation. (orig.)

  17. Arterial spin labelling MRI for detecting pseudocapsule defects and predicting renal capsule invasion in renal cell carcinoma.

    Science.gov (United States)

    Zhang, H; Wu, Y; Xue, W; Zuo, P; Oesingmann, N; Gan, Q; Huang, Z; Wu, M; Hu, F; Kuang, M; Song, B

    2017-11-01

    To evaluate prospectively the performance of combining morphological and arterial spin labelling (ASL) magnetic resonance imaging (MRI) for detecting pseudocapsule defects in renal cell carcinoma (RCC), and to predict renal capsule invasion confirmed histopathologically. Twenty consecutive patients with suspicious renal tumours underwent MRI. Renal ASL imaging was performed and renal blood flow was measured quantitatively. The diagnostic performance of T2-weighted images alone, and a combination of T2-weighted and ASL images for predicting renal capsule invasion were assessed. Twenty renal lesions were evaluated in 20 patients. All lesions were clear cell RCCs (ccRCCs) confirmed at post-surgical histopathology. Fifteen ccRCCs showed pseudocapsule defects on T2-weighted images, of which 12 cases showed existing blood flow in defect areas on perfusion images. To predict renal capsule invasion, the sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 71.4%, 86.7%, 100%, respectively, for T2-weighted images alone, and 92.3%, 100%, 100%, 87.5%, respectively, for the combination of T2-weighted and ASL images. ASL images can reflect the perfusion of pseudocapsule defects and as such, the combination of T2-weighted and ASL images produces promising diagnostic accuracy for predicting renal capsule invasion. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  18. Anatomic assessment of sympathetic peri-arterial renal nerves in man.

    Science.gov (United States)

    Sakakura, Kenichi; Ladich, Elena; Cheng, Qi; Otsuka, Fumiyuki; Yahagi, Kazuyuki; Fowler, David R; Kolodgie, Frank D; Virmani, Renu; Joner, Michael

    2014-08-19

    Although renal sympathetic denervation therapy has shown promising results in patients with resistant hypertension, the human anatomy of peri-arterial renal nerves is poorly understood. The aim of our study was to investigate the anatomic distribution of peri-arterial sympathetic nerves around human renal arteries. Bilateral renal arteries were collected from human autopsy subjects, and peri-arterial renal nerve anatomy was examined by using morphometric software. The ratio of afferent to efferent nerve fibers was investigated by dual immunofluorescence staining using antibodies targeted for anti-tyrosine hydroxylase and anti-calcitonin gene-related peptide. A total of 10,329 nerves were identified from 20 (12 hypertensive and 8 nonhypertensive) patients. The mean individual number of nerves in the proximal and middle segments was similar (39.6 ± 16.7 per section and 39.9 ± 1 3.9 per section), whereas the distal segment showed fewer nerves (33.6 ± 13.1 per section) (p = 0.01). Mean subject-specific nerve distance to arterial lumen was greatest in proximal segments (3.40 ± 0.78 mm), followed by middle segments (3.10 ± 0.69 mm), and least in distal segments (2.60 ± 0.77 mm) (p renal sympathetic nerve fibers is lower in distal segments and dorsal locations. There is a clear predominance of efferent nerve fibers, with decreasing prevalence of afferent nerves from proximal to distal peri-arterial and renal parenchyma. Understanding these anatomic patterns is important for refinement of renal denervation procedures. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Vascular fluorscene casting and imaging cryomicrotomy for computerized three-dimensional renal arterial reconstruction

    NARCIS (Netherlands)

    Lagerveld, B.W.; Wee, ter R.; Rosette, de la J.J.M.C.H.; Spaan, J.A.; Wijkstra, H.

    2010-01-01

    OBJECTIVE To assess the combined use of a casting technique, cryomicrotomy imaging, and three-dimensional (3D) computer analysis as a method for visualizing and reconstructing the arterial vascular tree in a porcine renal model. MATERIAL AND METHODS The arterial branches of two porcine kidneys were

  20. Vascular fluorescence casting and imaging cryomicrotomy for computerized three-dimensional renal arterial reconstruction

    NARCIS (Netherlands)

    Lagerveld, Brunolf W.; ter Wee, Rene D.; de La Rosette, Jean J. M. C. H.; Spaan, Jos A. E.; Wijkstra, Hessel

    2007-01-01

    OBJECTIVES To assess the combined use of a casting technique, cryomicrotomy imaging, and three-dimensional (3D) computer analysis as a method for visualizing and reconstructing the arterial vascular tree in a porcine renal model. MATERIAL AND METHODS The arterial branches of two porcine kidneys were

  1. Dynamic Geometric Analysis of the Renal Arteries and Aorta following Complex Endovascular Aneurysm Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Kim, John J; Lee, Jason T; Dalman, Ronald L; Cheng, Christopher P

    2017-08-01

    Aneurysm regression and target vessel patency during early and mid-term follow-up may be related to the effect of stent-graft configuration on the anatomy. We quantified geometry and remodeling of the renal arteries and aneurysm following fenestrated (F-) or snorkel/chimney (Sn-) endovascular aneurysm repair (EVAR). Twenty-nine patients (mean age, 76.8 ± 7.8 years) treated with F- or Sn-EVAR underwent computed tomography angiography at preop, postop, and follow-up. Three-dimensional geometric models of the aorta and renal arteries were constructed. Renal branch angle was defined relative to the plane orthogonal to the aorta. End-stent angle was defined as the angulation between the stent and native distal artery. Aortic volumes were computed for the whole aorta, lumen, and their difference (excluded lumen). Renal patency, reintervention, early mortality, postoperative renal impairment, and endoleak were reviewed. From preop to postop, F-renal branches angled upward, Sn-renal branches angled downward (P renals exhibited increased end-stent angulation (12 ± 15°, P renals, whereas F-renals exhibited increased end-stent angulation (5 ± 10°, P renal stent patency was 94.1% and renal impairment occurred in 2 patients (6.7%). Although F- and Sn-EVAR resulted in significant, and opposite, changes to renal branch angle, only Sn-EVAR resulted in significant end-stent angulation increase. Longitudinal geometric analysis suggests that these anatomic alterations are primarily generated early as a consequence of the procedure itself and, although persistent, they show no evidence of continued significant change during the subsequent postoperative follow-up period. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Mady Charles

    2007-09-01

    Full Text Available Abstract Background In patients with advanced non-ischemic cardiomyopathy (NIC, right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA flow pattern and flow reserve (CFR are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR. Methods Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire data was obtained in RCA and left anterior descendent coronary artery (LAD before and after adenosine. Resting RCA phasic pattern (diastolic/systolic was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR. Results LV fractional shortening and end diastolic diameter were 15.3 ± 3.5 % and 69.4 ± 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS; RCA vs. LAD was 1.35 vs. 2.85 (p Conclusion In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV dysfunction. There is no significant correlation between any cardiac mechanical-structural or

  3. Endovascular repair of renal artery aneurysm with the multilayer stent – a short report

    Directory of Open Access Journals (Sweden)

    Vojko Flis

    2012-10-01

    in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent. Conclusion: New multilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case.

  4. Efficacy of percutaneous transluminal renal angioplasty with stent in elderly male patients with atherosclerotic renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Zhao J

    2012-10-01

    Full Text Available Jiahui Zhao, Qingli Cheng, Xiaoying Zhang, Meihua Li, Sheng Liu, Xiaodan WangDepartment of Geriatric Nephrology, Chinese PLA General Hospital, Beijing, ChinaObjectives: Percutaneous transluminal renal angioplasty with stent implantation (PTRAS has become the treatment of choice for atherosclerotic renal artery stenosis (ARAS. This study evaluates the long-term effects of PTRAS on hypertension and renal function in elderly patients with ARAS.Methods: We conducted a retrospective cohort study of all patients who underwent PTRAS in the geriatric division of a tertiary medical center during the period 2003–2010. The clinical data were extracted from the medical records of each patient. Changes in blood pressure, antihypertensive treatment, and estimated glomerular filtration rate were analyzed before and after PTRAS.Results: Eighty-six stents in 81 elderly patients were placed successfully. The average age of the patients was 76.2 years (65–89 years. Mean follow-up was 31.3 months (range 12 –49 months. There was a significant decrease in both systolic and diastolic blood pressure at the third day after the PTRAS procedure and the reduction in blood pressure was constant throughout the follow-up period until 36 months after PTRAS. However, there was no marked benefit to renal function outcome during the follow-up period. The incidence of contrast-induced nephropathy was 9.9% in this study group. The rate of renal artery restenosis was 14.8%. The survival rate was 96.3% for 4 years after the procedure.Conclusion: It is beneficial to control blood pressure in elderly patients with ARAS up to 36 months after a PTRAS procedure. However, their renal function improvement is limited.Keywords: angioplasty, hypertension, renal function, elderly, renal artery stenosis

  5. Assessment value of transcranial Doppler hemodynamic typing for prognosis of patients with acute middle cerebral artery infarction

    Directory of Open Access Journals (Sweden)

    Jing Xie

    2016-08-01

    Full Text Available Objective: To analyze the assessment value of transcranial Doppler hemodynamic typing for prognosis of patients with acute middle cerebral artery infarction. Methods: A total of 54 cases of patients with acute middle cerebral artery infarction who received treatment in our hospital from January 2014 to June 2015 were included for study, and according to different types, they were divided into total occlusion group 17 cases, partial occlusion group 28 cases and nonocclusion group 9 cases. Differences in levels of infarction-related proteins, coagulation-related indicators, illness-related factors, etc in circulating blood of three groups were compared, and the correlation of middle cerebral arterial systolic velocity (Vs and diastolic velocity (Vd with above indicators was further analyzed. Results: Vs and Vd values of non-occlusion group were higher than those of total occlusion group and partial occlusion group, and Vs and Vd values of partial occlusion group were higher than those of total occlusion group; serum Gelsolin, PT, APTT and TT values of non-occlusion group were higher, SAA, Apo- CⅡ, HbA1c, GSP, A毬, HSP70, FIB, D-D, Copeptin, P-selectin, PTX3, TPO and FFA values were lower, and compared with partial occlusion group and total occlusion group, differences were significant; Gelsolin, PT, APTT and TT values of partial occlusion group were higher than those of total occlusion group, and SAA, Apo- CⅡ, HbA1c, GSP, A毬, HSP70, FIB, D-D, Copeptin, P-selectin, PTX3, TPO and FFA values were lower than those of total occlusion group; middle cerebral arterial Vs and Vd values were directly proportional to Gelsolin, PT, APTT and TT values, and inversely proportional to SAA, Apo- CⅡ, HbA1c, GSP, A毬, HSP70, FIB, D-D, Copeptin, P-selectin, PTX3, TPO and FFA values. Conclusions: Transcranial Doppler hemodynamic typing can be the reliable way to judge the severity of acute middle cerebral artery infarction, and has great value in assessing

  6. Renal damage induced by dosorubicin-lipiodol emulsion infused into rabbit renal artery : comparison with CT and histologic findings

    International Nuclear Information System (INIS)

    Kim, Jin Gyoo; Moon, Tae Young; Lee, Suck Hong; Kim, Byung Soo; Choi, Sang Yul; Park, Choong Hoon

    1998-01-01

    The purpose of this study is to evaluate the utility of renal CT scanning and to histologically correlate renal damage induced by renal arterial infusion of 0.2 ml/kg of doxorubicin-lipiodol emulsion. Renal CT scans of 20 rabbit kidneys were obtained 15 days after transcatheter arterial chemoembolization and were classified into four grades, as follows: grade 0 - no fleck, grade 1 - one to three nodular flecks; grade 2 - four or more nodular flecks, or one semilunar fleck; and grade 3 - two or more semilunar flecks. The percentage of histological section occupied by lesion was determined using squared paper, and compared with the grades determined on the basis of CT. The histologic findings were interstitial inflammatory cell infiltration, intratubular lipiodol droplets, dystrophic calcification, and and cellular necrosis. The mean sizes of grade 0, 1, 2 and 3 histological lesions were 2.2 % (n=5), 4.5 % (n=4), 21.9 % (n=7), and 24% (n=4), respectively. Grades 0 and 1 accounted for nine cases (3.2%), while grades 2 and 3 accounted for 11 (22.6%); this difference was statistically significant (p<0.01). CT findings showing nodular or semilunar flecks 15 days after infusion into the renal artery of doxorubicin-lipiodol emulsion correlate with the size of the damaged kidney, as seen on histological specimens. (author). 19 refs., 3 tabs., 5 figs

  7. Transcatheter Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer

    International Nuclear Information System (INIS)

    Rautio, Riitta; Haapanen, Arto

    2007-01-01

    Our aim was to treat a clinically silent renal artery aneurysm. The patient was a 76-year-old man with elevated prostate-specific antigen and prostata biopsies with a gradus II-III adenocarcinoma who was incidentally found to have an aneurysm in his right renal artery. We performed a successful transcatheter embolization of the aneurysm using ethylene vinyl alcohol copolymer (Onyx). To avoid migration of the liquid material into the parent artery, a balloon was inflated in the orifice of the neck of the aneurysm while the liquid was injected. Five-month follow-up computed tomography (CT) imaging confirmed total occlusion of the aneurysm

  8. Effects of neuromuscular electrical stimulation on arterial hemodynamic properties and body composition in paretic upper extremities of patients with subacute stroke

    Directory of Open Access Journals (Sweden)

    Shu-Chun Huang

    2014-08-01

    Full Text Available Background: Neuromuscular electric stimulation (NMES induces repeated muscular contraction, possibly promoting the perfusion/oxygenation of the regional tissues. It remains unclear how NMES influences vascular hemodynamic property and segmental fluid distribution/composition in paretic extremities of hemiplegic patients. Methods: Eleven hemiplegic patients aged 62.6 ± 12.5 years in the subacute stage of stroke received NMES for paretic wrist extensor and flexor muscles 30 min daily, 5 days per week for 4 weeks. The non-paretic upper extremities (NPUE that did not receive NMES served as control. Distribution of fluid to intra/extracellular milieu and arterial hemodynamic properties were determined by using the multi-frequency bioelectrical impedance and pulse wave analysis, respectively. Results: Compared with NPUE without NMES, paretic upper extremity (PUE with NMES revealed a significantly less decrease in arterial blood flow, impedance quotient, slope quotient, and less increase in crest width and crest time of arterial pulse wave. NMES for 4 weeks increased body cell mass in PUE. Furthermore, NPUE without NMES reduced intracellular water, whereas PUE with NMES retarded loss of intracellular water after stroke. Conclusion: NMES therapy increases body cell mass, attenuates reduction of intracellular water, and alleviates arterial hemodynamic disturbance in PUE in subacute stroke. However, stroke-related physical deconditioning may negatively regulate body composition and impair hemodynamic function in NPUE.

  9. Hemodynamic and glucometabolic factors fail to predict renal function in a random population sample

    DEFF Research Database (Denmark)

    Pareek, M.; Nielsen, M.; Olesen, Thomas Bastholm

    2015-01-01

    indices of beta-cell function (HOMA-2B), insulin sensitivity (HOMA-2S), and insulin resistance (HOMA-2IR)), traditional cardiovascular risk factors (age, sex, smoking status, body mass index, diabetes mellitus, total serum cholesterol), and later renal function determined as serum cystatin C in 238 men...

  10. Orbital Atherectomy in the Renal Artery: A New Frontier for an Emerging Technology?

    Science.gov (United States)

    Valle, Javier A; Armstrong, Ehrin J; Waldo, Stephen W

    2017-01-01

    Orbital atherectomy has been developed as a method to modify calcified plaque in the peripheral vasculature, with extensive experience and data supporting its use in infrainguinal peripheral arterial disease. However, calcific atherosclerotic disease occurs in other vascular beds and may benefit from the application of this technology. In this case report, we describe the first reported use of orbital atherectomy in a renal artery. A 55-year-old male with severe drug-refractory hypertension was found to have renal artery stenosis, with severe calcification of the right renal artery. Orbital atherectomy was utilized for initial plaque modification, and he underwent stenting of the renal artery lesion with an excellent angiographic and clinical result at follow-up. In conclusion, orbital atherectomy is a safe and effective means of plaque modification for severely calcified lesions. The safe and effective use of orbital atherectomy in the renal vasculature suggests an opportunity for ongoing evaluation into expanded roles for this technology beyond the coronary and lower-extremity arterial beds.

  11. Renal Artery Variations, Hilar Arrangement and Its Distances to Ventral Branches of Abdominal Aorta: A Morphometric Study

    Directory of Open Access Journals (Sweden)

    D'Souza A

    2015-10-01

    Full Text Available Purpose: To measure the distance of origin of renal artery in relation to the ventral branches of abdominal aorta and also to study the variations in the number and the hilar branching pattern of renal arteries. Materials and methods: The present study was carried out using ten embalmed adult cadavers. The distances were measured bilaterally from the origin of renal artery to the origin of superior and inferior mesenteric artery and the bifurcation of abdominal aorta. Results: Out of ten cadavers studied, bilateral accessory renal artery was observed in two cases. The hilar branching pattern varied from a single artery to maximum of six branches. The mean and standard deviations of the measured parameters were calculated. Conclusion: Knowledge of variations of renal artery is important for surgeons in performing many procedures and may help to avoid clinical complications in the abdominal region.

  12. Rupture of the Renal Artery After Cutting Balloon Angioplasty in a Young Woman With Fibromuscular Dysplasia

    International Nuclear Information System (INIS)

    Oguzkurt, Levent; Tercan, Fahri; Gulcan, Oner; Turkoz, Riza

    2005-01-01

    A 24-year-old woman with uncontrollable high blood pressure for 3 months had significant stenosis of the left renal artery caused by fibromuscular dysplasia (FMD). The lesion was resistant to percutaneous transluminal angioplasty at 18 atm with a semicompliant balloon. Angioplasy with a 6 x 10 mm cutting balloon (CB) caused rupture of the artery. Low-pressure balloon inflation decreased but did not stop the leak. An attempt to place a stent-graft (Jostent; Jomed, Rangendingen, Germany) failed, and a bare, 6-mm balloon-expandable stent (Express SD; Boston Scientific, MN) was deployed to seal the leak, which had decreased considerably after long-duration balloon inflation. The bleeding continued, and the patient underwent emergent surgical revascularization of the renal artery with successful placement of a 6-mm polytetrafluoroethylene bypass graft. CBs should be used very carefully in the treatment of renal artery stenosis, particularly in patients with FMD

  13. Safety of non-ionic contrast media during renal artery stenting

    International Nuclear Information System (INIS)

    Ni Jun; Shen Weifeng; Zhang Ruiyan; Zhang Qi; Zhang Xian; Zheng Aifang

    2004-01-01

    Objective: To evaluate the safety of non-ionic contras media during interventional treatment of renal artery stenosis (RAS). Methods: Fifty four coronary artery disease patients associated with RAS (luminal narrowing > 50%) underwent renal artery stent implantation and percutaneous coronary intervention, only 10 of them with merely renoarterial stenosis undergone renal artery stent implantation. The successful rates of the procedure and complication together with the volumes of contrast media were recorded respectively. And the serum creatine before and 12 hours after the successful procedure were also measured. Results: Both rates of procedural success and complication were similar among the three groups. The serum creatine levels, 12 hours after the procedure, showed no difference in comparing with the baseline. Conclusion: Non-ionic contrast media (Iopamiro 370) could be safely used in patients with RAS. (authors)

  14. Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience

    International Nuclear Information System (INIS)

    Pedrosa, Ivan; Rafatzand, Khashayar; Robson, Philip; Alsop, David C.; Wagner, Andrew A.; Atkins, Michael B.; Rofsky, Neil M.

    2012-01-01

    To retrospectively evaluate the feasibility of arterial spin labeling (ASL) magnetic resonance imaging (MRI) for the assessment of vascularity of renal masses in patients with impaired renal function. Between May 2007 and November 2008, 11/67 consecutive patients referred for MRI evaluation of a renal mass underwent unenhanced ASL-MRI due to moderate-to-severe chronic or acute renal failure. Mean blood flow in vascularised and non-vascularised lesions and the relation between blood flow and final diagnosis of malignancy were correlated with a 2-sided homogeneous variance t-test and the Fisher Exact Test, respectively. A p value 2 (range 7-39). The average blood flow of 11 renal masses interpreted as ASL-positive (134 +/- 85.7 mL/100 g/min) was higher than that of 6 renal masses interpreted as ASL-negative (20.5 +/- 8.1 mL/100 g/min)(p = 0.015). ASL-positivity correlated with malignancy (n = 3) or epithelial atypia (n = 1) at histopathology or progression at follow up (n = 7). ASL detection of vascularity in renal masses in patients with impaired renal function is feasible and seems to indicate neoplasia although the technique requires further evaluation. (orig.)

  15. Responsiveness of internal thoracic arteries to nitroglycerin in patients with renal failure.

    Science.gov (United States)

    Tawa, Masashi; Kinoshita, Takeshi; Asai, Tohru; Suzuki, Tomoaki; Ishibashi, Takaharu; Okamura, Tomio

    2017-12-11

    Nitroglycerin is commonly used as an antispasmodic for treating spasm of coronary artery bypass grafts. This study investigated whether the presence of renal failure affects reactivity to nitroglycerin in internal thoracic arteries obtained from patients undergoing coronary bypass surgery. The patients were divided into three groups according to estimated glomerular filtration rate (eGFR, mL/min/1.73 m 2 ): without renal failure (60 ≤ eGFR, n = 13), with moderate renal failure (30 ≤ eGFR renal failure (eGFR renal failure than in those without renal failure. In addition, there was a negative correlation between eGFR and the relaxant efficacy of nitroglycerin (P = 0.016). On the other hand, relaxant responses to BAY 60-2770 (which enhances cGMP generation as with nitroglycerin) were similar among three grades of renal function. An inverse relationship of eGFR to the relaxant efficacy of BAY 60-2770 was not observed, either (P = 0.314). These findings suggest that severe renal failure specifically potentiates nitroglycerin-induced relaxation in internal thoracic artery grafts.

  16. Influence of stenosis on hemodynamic parameters in the realistic left coronary artery under hyperemic conditions.

    Science.gov (United States)

    Kamangar, Sarfaraz; Badruddin, Irfan Anjum; Badarudin, A; Nik-Ghazali, N; Govindaraju, Kalimuthu; Salman Ahmed, N J; Yunus Khan, T M

    2017-03-01

    The current study investigates the hyperemic flow effects on heamodynamics parameters such as velocity, wall shear stress in 3D coronary artery models with and without stenosis. The hyperemic flow is used to evaluate the functional significance of stenosis in the current era. Patients CT scan data of having healthy and coronary artery disease was chosen for the reconstruction of 3D coronary artery models. The diseased 3D models of coronary artery shows a narrowing of >50% lumen area. Computational fluid dynamics was performed to simulate the hyperemic flow condition. The results showed that the recirculation zone was observed immediate to the stenosis and highest wall shear stress was observed across the stenosis. The decrease in pressure was found downstream to the stenosis as compared to the coronary artery without stenosis. Our analysis provides an insight into the distribution of wall shear stress and pressure drop, thus improving our understanding of hyperemic flow effect under both conditions.

  17. The acute hemodynamic effects of intravenous verapamil in coronary artery disease. Assessment by equilibrium-gated radionuclide ventriculography

    International Nuclear Information System (INIS)

    Klein, H.O.; Ninio, R.; Oren, V.; Lang, R.; Sareli, P.; DiSegni, E.; David, D.; Guerrero, J.; Kaplinsky, E.

    1983-01-01

    The acute hemodynamic effects of an i.v. bolus of verapamil, 0.1 mg/kg or 0.06-0.075 mg/kg, were examined by serial radionuclide studies in 46 patients with coronary artery disease. In 20 patients with ejection fractions (EFs) greater than 35% (group 1A), verapamil, 0.1 mg/kg given over 1-11/2 minutes, had a biphasic effect: first, a transient decrease in EF accompanied by increased left ventricular (LV) volumes and cardiac output equivalents; then, an overshoot of EF to values above control, accompanied by a decrease in peripheral vascular resistance and a drastic decrease in LV volumes, while cardiac output equivalent remained slightly elevated. In eight patients with EFs less than 35% (group 1B), only the first effect on EF was noted. In 10 patients with EFs greater than 35% (group 2), verapamil, 0.06-0.075 mg/kg, exerted qualitatively similar but milder effects on hemodynamic function. Finally, verapamil, 0.1 mg/kg given more slowly, over 2-21/2 minutes, produced no significant changes in EF or LV volumes in another eight patients (group 3). The acute effects of verapamil are thus both time-related and dose-dependent. They are also related to the baseline functional reserve of the left ventricle. This study documents that verapamil exerts a depressant effect on LV function. However, the transient nature of this depression and the quick recovery to normal or above-normal values indicate that verapamil, in the doses used in this study, is safe to use intravenously in patients with coronary artery disease

  18. Dipyridamole-induced ST segment depression during thallium-201 imaging in patients with coronary artery disease: angiographic and hemodynamic determinants

    International Nuclear Information System (INIS)

    Chambers, C.E.; Brown, K.A.

    1988-01-01

    To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34%) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral vessels, jeopardized collateral vessels, multivessel disease), hemodynamic changes (changes in heart rate, systolic pressure, diastolic pressure and rate-pressure product), thallium-201 results (perfusion defect, thallium-201 redistribution) and demographic data (age, gender, medications). Only the presence of good coronary collateral vessels (p less than 0.02) and increases in rate-pressure product after dipyridamole infusion (p less than 0.02) were significant multivariate predictors of dipyridamole-induced ST depression. Good collateral vessels were more common in the group with ST depression (11 [79%] of 14) than they were in the group without ST depression (6 [22%] of 27; p less than 0.001). Rate-pressure product increased 2,835 +/- 1,648 beats/min.mm Hg in the group with ST depression compared with 1,179 +/- 1,417 beats/min.mm Hg in patients without ST depression (p less than 0.005). In conclusion, dipyridamole-induced ST segment depression in patients with coronary artery disease appears to be related to 1) the presence of good coronary collateral vessels, which may act by facilitating coronary steal, and 2) increases in rate-pressure product, reflecting increased myocardial oxygen demand. These observations may explain the lack of prognostic value of dipyridamole-induced ST segment depression described in previous reports

  19. Renal artery stenosis and hypertension after abdominal irradiation for Hodgkin disease. Successful treatment with nephrectomy

    International Nuclear Information System (INIS)

    Salvi, S.; Green, D.M.; Brecher, M.L.; Magoos, I.; Gamboa, L.N.; Fisher, J.E.; Baliah, T.; Afshani, E.

    1983-01-01

    Hypertension secondary to stenosis of the left renal artery developed in a thirteen-year-old male six years after completion of inverted Y irradiation (3,600 rad) for abdominal Hodgkin disease. Surgical treatment with nephrectomy resulted in control of the hypertension without the use of antihypertensive agents. We review the literature for this unusual complication of abdominal irradiation, and recommend that a 99mTc-DMSA renal scan, selective renal vein sampling for renin determinations, and renal arteriography be performed on any patient in whom hypertension develops following abdominal irradiation in childhood

  20. Renal oxygenation and hemodynamics in acute kidney injury and chronic kidney disease

    Science.gov (United States)

    Singh, Prabhleen; Ricksten, Sven-Erik; Bragadottir, Gudrun; Redfors, Bengt; Nordquist, Lina

    2013-01-01

    Summary 1. Acute kidney injury (AKI) puts a major burden on health systems that may arise from multiple initiating insults, including ischemia-reperfusion injury, cardiovascular surgery, radio-contrast administration as well as sepsis. Similarly, the incidence and prevalence of chronic kidney disease (CKD) continues to increase with significant morbidity and mortality. Moreover, an increasing number of AKI patients survive to develop CKD and end-stage kidney disease (ESRD). 2. Although the mechanisms for development of AKI and progression of CKD remain poorly understood, initial impairment of oxygen balance is likely to constitute a common pathway, causing renal tissue hypoxia and ATP starvation that will in turn induce extracellular matrix production, collagen deposition and fibrosis. Thus, possible future strategies for one or both conditions may involve dopamine, loop-diuretics, inducible nitric oxide synthase inhibitors and atrial natriuretic peptide, substances that target kidney oxygen consumption and regulators of renal oxygenation such as nitric oxide and heme oxygenase-1. PMID:23360244

  1. Late unıon of the renal veıns wıth the ınterposed left renal artery

    OpenAIRE

    Çavdar, Safiye; Şehirli, Ümit; Malcic-Gürbüz, Jasna; Gümüşçü, Burak; Akalın, Aytül

    2003-01-01

    The complicated embryological development of the renal vein shows extensive variability in its anatomy. In this study, the rare bilateral late union of the renal veins with the interposed renal artery was observed during dissection for educational purposes. Its significance in different clinical conditions has been discussed.

  2. Importance of Collateralization in Patients With Large Artery Intracranial Occlusive Disease: Long-Term Longitudinal Assessment of Cerebral Hemodynamic Function

    Directory of Open Access Journals (Sweden)

    Larissa McKetton

    2018-04-01

    Full Text Available Patients with large artery intracranial occlusive disease (LAICOD are at risk for both acute ischemia and chronic hypoperfusion. Collateral circulation plays an important role in prognosis, and imaging plays an essential role in diagnosis, treatment planning, and prognosis of patients with LAICOD. In addition to standard structural imaging, assessment of cerebral hemodynamic function is important to determine the adequacy of collateral supply. Among the currently available methods of assessment of cerebral hemodynamic function, measurement of cerebrovascular reactivity (CVR using blood oxygen level-dependent (BOLD MRI and precisely controlled CO2 has shown to be a safe, reliable, reproducible, and clinically useful method for long-term assessment of patients. Here, we report a case of long-term follow-up in a 28-year-old Caucasian female presented to the neurology clinic with a history of TIAs and LAICOD of the right middle cerebral artery (MCA. Initial structural MRI showed a right MCA stenosis and a small right coronal radiate lacunar infarct. Her CVR study showed a large area of impaired CVR with a paradoxical decrease in BOLD signal with hypercapnia involving the right MCA territory indicating intracerebral steal. The patient was managed medically with anticoagulant and antiplatelet therapy and was followed-up for over 9 years with both structural and functional imaging. Cortical thickness (CT measures were longitudinally assessed from a region of interest that was applied to subsequent time points in the cortical region exhibiting steal physiology and in the same region of the contralateral healthy hemisphere. In the long-term follow-up, the patient exhibited improvement in her CVR as demonstrated by the development of collaterals with negligible changes to CT. Management of patients with LAICOD remains challenging since no revascularization strategies have shown efficacy except in patients with moyamoya disease. Management is well

  3. Importance of Collateralization in Patients With Large Artery Intracranial Occlusive Disease: Long-Term Longitudinal Assessment of Cerebral Hemodynamic Function.

    Science.gov (United States)

    McKetton, Larissa; Venkatraghavan, Lakshmikumar; Poublanc, Julien; Sobczyk, Olivia; Crawley, Adrian P; Rosen, Casey; Silver, Frank L; Duffin, James; Fisher, Joseph A; Mikulis, David J

    2018-01-01

    Patients with large artery intracranial occlusive disease (LAICOD) are at risk for both acute ischemia and chronic hypoperfusion. Collateral circulation plays an important role in prognosis, and imaging plays an essential role in diagnosis, treatment planning, and prognosis of patients with LAICOD. In addition to standard structural imaging, assessment of cerebral hemodynamic function is important to determine the adequacy of collateral supply. Among the currently available methods of assessment of cerebral hemodynamic function, measurement of cerebrovascular reactivity (CVR) using blood oxygen level-dependent (BOLD) MRI and precisely controlled CO 2 has shown to be a safe, reliable, reproducible, and clinically useful method for long-term assessment of patients. Here, we report a case of long-term follow-up in a 28-year-old Caucasian female presented to the neurology clinic with a history of TIAs and LAICOD of the right middle cerebral artery (MCA). Initial structural MRI showed a right MCA stenosis and a small right coronal radiate lacunar infarct. Her CVR study showed a large area of impaired CVR with a paradoxical decrease in BOLD signal with hypercapnia involving the right MCA territory indicating intracerebral steal. The patient was managed medically with anticoagulant and antiplatelet therapy and was followed-up for over 9 years with both structural and functional imaging. Cortical thickness (CT) measures were longitudinally assessed from a region of interest that was applied to subsequent time points in the cortical region exhibiting steal physiology and in the same region of the contralateral healthy hemisphere. In the long-term follow-up, the patient exhibited improvement in her CVR as demonstrated by the development of collaterals with negligible changes to CT. Management of patients with LAICOD remains challenging since no revascularization strategies have shown efficacy except in patients with moyamoya disease. Management is well defined for acute

  4. Hemodynamically significant stenosis of the internal carotid artery treated with endarterectomy. Case report

    DEFF Research Database (Denmark)

    Vorstrup, S; Engell, Hans; Lindewald, H

    1984-01-01

    symptoms. Diamox (acetazolamide, 1 gm) increased CBF by 24% in the unaffected hemisphere, whereas even a slight decrease in flow ("steal") was seen in the maximally affected region. In contrast, theophylline (220 mg) reduced CBF in the unaffected hemisphere and caused a slight increase in the previously...... maximally hypoperfused area ("inverse steal"). After surgery, the flow pattern practically normalized and the TIA's disappeared. The CBF measurements before surgery and also after the injection of the vasoactive drugs indicated that focal hemodynamic insufficiency elicited the TIA's, and pointed at a low...

  5. Inhibition of p38 MAPK attenuates renal atrophy and fibrosis in a murine renal artery stenosis model.

    Science.gov (United States)

    Wang, Diping; Warner, Gina M; Yin, Ping; Knudsen, Bruce E; Cheng, Jingfei; Butters, Kim A; Lien, Karen R; Gray, Catherine E; Garovic, Vesna D; Lerman, Lilach O; Textor, Stephen C; Nath, Karl A; Simari, Robert D; Grande, Joseph P

    2013-04-01

    Renal artery stenosis (RAS) is an important cause of chronic renal dysfunction. Recent studies have underscored a critical role for CCL2 (MCP-1)-mediated inflammation in the progression of chronic renal damage in RAS and other chronic renal diseases. In vitro studies have implicated p38 MAPK as a critical intermediate for the production of CCL2. However, a potential role of p38 signaling in the development and progression of chronic renal disease in RAS has not been previously defined. We sought to test the hypothesis that inhibition of p38 MAPK ameliorates chronic renal injury in mice with RAS. We established a murine RAS model by placing a cuff on the right renal artery and treated mice with the p38 inhibitor SB203580 or vehicle for 2 wk. In mice treated with vehicle, the cuffed kidney developed interstitial fibrosis, tubular atrophy, and interstitial inflammation. In mice treated with SB203580, the RAS-induced renal atrophy was reduced (70% vs. 39%, P < 0.05). SB203580 also reduced interstitial inflammation and extracellular matrix deposition but had no effect on the development of hypertension. SB203580 partially blocked the induction of CCL2, CCL7 (MCP-3), CC chemokine receptor 2 (CCR2), and collagen 4 mRNA expression in the cuffed kidneys. In vitro, blockade of p38 hindered both TNF-α and TGF-β-induced CCL2 upregulation. Based on these observations, we conclude that p38 MAPK plays a critical role in the induction of CCL2/CCL7/CCR2 system and the development of interstitial inflammation in RAS.

  6. Anatomic distribution of renal artery stenosis in children: implications for imaging.

    Science.gov (United States)

    Vo, Nghia J; Hammelman, Ben D; Racadio, Judy M; Strife, C Frederic; Johnson, Neil D; Racadio, John M

    2006-10-01

    Renal artery stenosis (RAS) causes significant hypertension in children. Frequently, pediatric RAS occurs with systemic disorders. In these cases, stenoses are often complex and/or include long segments. We believed that hypertensive children without comorbid conditions had a different lesion distribution and that the difference might have implications for imaging and treatment. To identify locations of RAS lesions in these hypertensive children without comorbid conditions. Patients who had renal angiography for hypertension from 1993 to 2005 were identified. Patients with systemic disorders, renovascular surgery, or normal angiograms were excluded. The angiograms of the remaining patients were reviewed for number, type, and location of stenoses. Eighty-seven patients underwent renal angiography for hypertension; 30 were excluded for comorbid conditions. Twenty-one of the remaining 57 patients had abnormal angiograms; 24 stenoses were identified in those patients. All were focal and distributed as follows: 6 (25%) main renal artery, 12 (50%) 2nd order branch, 3 (12.5%) 3rd order branch, and 3 (12.5%) accessory renal artery. Hypertensive children without comorbid conditions who have RAS usually have single, focal branch artery stenoses. This distribution supports angiography in these patients because of its superior sensitivity in detecting branch vessel disease and its therapeutic role in percutaneous transluminal renal angioplasty.

  7. Anatomic distribution of renal artery stenosis in children: implications for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vo, Nghia J.; Racadio, Judy M.; Johnson, Neil D. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati, OH (United States); Hammelman, Ben D. [University of Cincinnati College of Medicine, Cincinnati, OH (United States); Strife, C.F. [Cincinnati Children' s Hospital Medical Center, Department of Pediatrics, Division of Nephrology and Hypertension, Cincinnati, OH (United States); Racadio, John M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital, Department of Radiology, Cincinnati, OH (United States)

    2006-10-15

    Renal artery stenosis (RAS) causes significant hypertension in children. Frequently, pediatric RAS occurs with systemic disorders. In these cases, stenoses are often complex and/or include long segments. We believed that hypertensive children without comorbid conditions had a different lesion distribution and that the difference might have implications for imaging and treatment. To identify locations of RAS lesions in these hypertensive children without comorbid conditions. Patients who had renal angiography for hypertension from 1993 to 2005 were identified. Patients with systemic disorders, renovascular surgery, or normal angiograms were excluded. The angiograms of the remaining patients were reviewed for number, type, and location of stenoses. Eighty-seven patients underwent renal angiography for hypertension; 30 were excluded for comorbid conditions. Twenty-one of the remaining 57 patients had abnormal angiograms; 24 stenoses were identified in those patients. All were focal and distributed as follows: 6 (25%) main renal artery, 12 (50%) 2nd order branch, 3 (12.5%) 3rd order branch, and 3 (12.5%) accessory renal artery. Hypertensive children without comorbid conditions who have RAS usually have single, focal branch artery stenoses. This distribution supports angiography in these patients because of its superior sensitivity in detecting branch vessel disease and its therapeutic role in percutaneous transluminal renal angioplasty. (orig.)

  8. Saccular aneurysm of segmental branch of the main renal artery: approach to diagnosis and treatment

    International Nuclear Information System (INIS)

    Karaman, B.; Hamcan, S.; Bozkurt, Y.; Kara, K.; Aslan, A.

    2012-01-01

    Full text: Introduction: Renal artery aneurysms rarely detected clinical situation. Mostly determined by symptoms such as hematuria, hypertension and flank pain. Generally detected during investigation of symptoms or incidentally. Objectives and tasks: We aim to present the findings of CTA and DSA of the 58-year-old male patient with flank pain, hematuria and hypertension complaints. Materials and methods: We performed CTA and selective renal angiography to 58-year-old male patient with complaints of hypertension, flank pain and hematuria. Results: Approximately 11.5x 13.5 mm size of saccular aneurysm at the upper segmental branch of the left renal artery and focal cortical infarct detected in CT abdomen of the patient before treatment. The aneurysm was confirmed with selective renal angiography examination and treated with Cardiatis stent in the same procedure. Conclusion: Primary goal of treatment of renal artery aneurysms is to prevent complications such as rupture and thrombosis. Renal artery aneurysms have been treated with open surgery previously. Parenchyma preventive and minimally invasive treatments such as Cardiatis stent placement successfully uses currently

  9. Anatomic distribution of renal artery stenosis in children: implications for imaging

    International Nuclear Information System (INIS)

    Vo, Nghia J.; Racadio, Judy M.; Johnson, Neil D.; Hammelman, Ben D.; Strife, C.F.; Racadio, John M.

    2006-01-01

    Renal artery stenosis (RAS) causes significant hypertension in children. Frequently, pediatric RAS occurs with systemic disorders. In these cases, stenoses are often complex and/or include long segments. We believed that hypertensive children without comorbid conditions had a different lesion distribution and that the difference might have implications for imaging and treatment. To identify locations of RAS lesions in these hypertensive children without comorbid conditions. Patients who had renal angiography for hypertension from 1993 to 2005 were identified. Patients with systemic disorders, renovascular surgery, or normal angiograms were excluded. The angiograms of the remaining patients were reviewed for number, type, and location of stenoses. Eighty-seven patients underwent renal angiography for hypertension; 30 were excluded for comorbid conditions. Twenty-one of the remaining 57 patients had abnormal angiograms; 24 stenoses were identified in those patients. All were focal and distributed as follows: 6 (25%) main renal artery, 12 (50%) 2nd order branch, 3 (12.5%) 3rd order branch, and 3 (12.5%) accessory renal artery. Hypertensive children without comorbid conditions who have RAS usually have single, focal branch artery stenoses. This distribution supports angiography in these patients because of its superior sensitivity in detecting branch vessel disease and its therapeutic role in percutaneous transluminal renal angioplasty. (orig.)

  10. Percutaneous Transluminal Angioplasty of Renal Artery Fibromuscular Dysplasia: Mid-term Results

    International Nuclear Information System (INIS)

    Kim, Hyo Jin; Do, Young Soo; Shin, Sung Wook; Park, Kwang Bo; Cho, Sung Ki; Choe, Yeon Hyeon; Choo, Sung Wook; Choo, In Wook; Kim, Duk Kyung

    2008-01-01

    To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD). Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated. The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA. Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA

  11. Evaluation of blood flow in Allograft Renal Arteries anastomosed with two different techniques

    International Nuclear Information System (INIS)

    Zomorrodi, A.; Bohluli, A.; Tarzamany, M.K.

    2008-01-01

    Renal artery stenosis in renal transplantation (TRAS) is an avoidable short or long term surgical complication. The etiology is multifactorial, but faulty anastomosis is a major factor. In our transplant center, we evaluated the incidence of TRAS with the use of two different suturing techniques of the anastomosis site between allograft renal and renal and iliac arteries in two groups of renal transplant recipients, group A: 14 patients (6 males and 8 females with age 16 to 59 and mean age of 38 years) in whom allograft arteries were anastomosed with a continuous suture technique and group B: 14 patients (7 males and 7 females with age 32 to 61 and mean age of 46.6 years) in whom the allograft arteries were anastomosed with a combined suture technique (continuous and uninterrupted. Post transplantation, the velocity of blood flow in the renal and iliac arteries at the site of anastomosis was measured by color Doppler ultrasound. The ultrasonographer was blinded to the surgical technique in both study groups. The ratio of the maximum velocity of blood at the site of anastomosis to that in the iliac artery of less than 2.5 was considered as non-significant stenosis, while a ratio of more than 2.5 was considered significant stenosis. In group A there were 9 cases of non-significant stenosis in comparison to 3 cases in group B, while there were no cases of significant stenosis in group A in comparison to 3 cases in group B; the difference was not statistically significant. We conclude that there was no difference in the compared surgical techniques of anastomosis in our study groups. This suggests that other factors such as gentle handling of tissue, enough spatula, margin reversion and comparable diameter of the anastomosed vessels may be more important in the prevention of renal allograft stenosis than the type of suture technique. (author)

  12. Detection of hemodynamic impairment using magnetic resonance angiography in patients with internal carotid artery stenoocclusive disease. Comparison with quantitative brain perfusion single-photon emission computed tomography

    International Nuclear Information System (INIS)

    Hirooka, Ryonoshin; Ogasawara, Kuniaki

    2008-01-01

    Cerebrovascular reactivity (CVR) to acetazolamideis a key parameter in determining the severity of hemodynamic impairment in patients with major cerebral artery occlusive disease. The aim of the present study is to validate the accuracy of magnetic resonance angiography (MRA) for detecting hemodynamic impairment by correlating detectability of the middle cerebral artery obtained by MRA with CVR measured by single-photon emission computed tomography (SPECT) in patients with internal carotid artery (ICA) occlusive disease. Ninety-four patients with chronic ICA occlusion underwent single slab three-dimensional time-of-flight MRA and SPECT. SPECT-CVR was calculated by measured cerebral blood flow before and after acetazolamide challenge. CVR was significantly lower in patients without detection of any portion (M1, M2 or M3) of the MCA than in those with detection of all portions. When SPECT-CVR lower than the mean- 2 standard deviation (SD) obtained in normal subjects was defined as reduced and the SPECT-CVR was assumed as the true determinant of hemodynamic impairment, MRA provided 92% sensitivity and 73% specificity, with 96% negative predictive value for detecting patients with reduced CVR. The present MRA method is effective for the identification of patients with hemodynamic impairment. (author)

  13. The prevalence of renal artery stenosis among patients with diabetes mellitus.

    Science.gov (United States)

    Postma, C T; Klappe, E M; Dekker, H M; Thien, Th

    2012-10-01

    Patients with diabetes mellitus (DM) have a high prevalence of atherosclerotic vascular lesions. It is therefore reasonable to assume that also the rate of renal artery stenosis (RAS) is higher. The presence of a RAS can have implications for the treatment of patients with diabetes mellitus and hypertension and renal impairment. Therefore it is important to be informed about the chance that a RAS is present among such patients. We prospectively studied the prevalence of atherosclerotic renal artery stenosis (RAS) among patients with diabetes mellitus. Patients were included if they were diagnosed with DM and hypertension with or without impairment of renal function. If causes of renal disease other than DM or hypertension were more probable on the basis of biochemical data, then such patients were excluded. A magnetic resonance angiography (MRA) of the renal arteries was made in 54 included successive patients. mean age 59 ± 8.5 years (range 35 to 80). Eight patients had DM 1 and 46 DM 2. Mean BMI was 31.4 ± 5.6 kg/m(2). A RAS was present in 18 of the 54 (33%) patients, 3 patients had bilateral stenoses. Factors related to the presence of RAS were diastolic blood pressure, glomerular filtration rate and dyslipidaemia. In this group of diabetic patients with hypertension and or renal impairment the prevalence of RAS was 33%. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  14. Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration

    International Nuclear Information System (INIS)

    Chou, Shinn-Huey; Wang, Zhen J.; Kuo, Jonathan; Cabarrus, Miguel; Fu Yanjun; Aslam, Rizwan; Yee, Judy; Zimmet, Jeffrey M.; Shunk, Kendrick; Elicker, Brett; Yeh, Benjamin M.

    2011-01-01

    Purpose: To examine the clinical significance of persistent renal enhancement after iodixanol administration. Methods: We retrospectively studied 166 consecutive patients who underwent non-enhanced abdominopelvic CT within 7 days after receiving intra-arterial (n = 99) or intravenous (n = 67) iodixanol. Renal attenuation was measured for each non-enhanced CT scan. Persistent renal enhancement was defined as CT attenuation >55 Hounsfield units (HU). Contrast-induced nephropathy (CIN) was defined as a rise in serum creatinine >0.5 mg/dL within 5 days after contrast administration. Results: While the intensity and frequency of persistent renal enhancement was higher after intra-arterial (mean CT attenuation of 73.7 HU, seen in 54 of 99 patients, or 55%) than intravenous contrast material administration (51.8 HU, seen in 21 of 67, or 31%, p < 0.005), a multivariate regression model showed that the independent predictors of persistent renal enhancement were a shorter time interval until the subsequent non-enhanced CT (p < 0.001); higher contrast dose (p < 0.001); higher baseline serum creatinine (p < 0.01); and older age (p < 0.05). The route of contrast administration was not a predictor of persistent renal enhancement in this model. Contrast-induced nephropathy was noted in 9 patients who received intra-arterial (9%) versus 3 who received intravenous iodixanol (4%), and was more common in patients with persistent renal enhancement (p < 0.01). Conclusion: Persistent renal enhancement at follow-up non-contrast CT suggests a greater risk for contrast-induced nephropathy, but the increased frequency of striking renal enhancement in patients who received intra-arterial rather than intravenous contrast material also reflects the larger doses of contrast and shorter time to subsequent follow-up CT scanning for such patients.

  15. Excretory urogramm with angiotomography: Imaging of the renal arteries by excretory urogramm

    International Nuclear Information System (INIS)

    Binder, G.

    1982-01-01

    Excretory urography permits imaging of the renal arteries up to the intrarenal ramification if the contrast medium is injected as a bolus and the time of circulation between arm vein and abdominal aorta is determined with sufficient accuracy. Imaging of the vessel phase is done using simultaneous tomography. In the experimental part of the paper phantom tests are carried through to establish the contrast medium concentration to be expected in the renal arteries by means of microdensitometry. With the aid of 100 computerized tomograms of the abdomen the layer thickness required was determined to 4.5 cm; further phantom tests provided the necessary layer distances to image renal arteries that do not run in parallel to the plain of the film. The circulation time between arm vein and abdominal aorta was measured in 180 patients using the radioisotope method. It ranges between 9 and 22 seconds. Comparisons with the Decholin-method were made. 739 renal arteries were seen during the evaluation of 343 excretory urographies with angiotomograms, in 83 per cent of the cases these arteries were presented entirely. Provided perfect execution, simultaneous tomography is a very informative method. For 212 patients the side-effects of the bolar contrast medium injection were recorded. The importance of excretory urography with combined angiotomography for the diagnosis of arterial hypertension is discussed. (orig.) [de

  16. Hemodynamic and renal implications of sodium-glucose cotransporter- 2 inhibitors in type 2 diabetes mellitus.

    Science.gov (United States)

    Tejedor Jorge, Alberto

    2016-11-01

    In DM2, there is increased expression of the proximal glucose transporter SGLT2. The increased glucose reabsorption from the urine to the proximal tubule and subsequently to the bloodstream, has three direct effects on the prognosis of patients with DM2: a) it increases the daily glucose load by raising the renal threshold for glucose, thus augmenting requirements for oral antidiabetics and insulin. This progressive increase occurs throughout the course of the disease and in parallel with the increase in renal mass (renal hypertrophy); b) because of the greater glucose reabsorption, glycosuria is lower than the level corresponding to glycaemia, decreasing the stimulus on the tubuloglomerular feedback system of the distal nephron. As a result, the glomerular vasodilation caused by hyperglycaemia is not arrested, maintaining glomerular hyperfiltration, and c) the excess glucose transported to the proximal tubular cells modifies their redox status, increasing local production of glycosylating products and activating local production of proinflammatory and profibrotic proliferative mediators. These mediators are responsible for the direct free radical damage to proximal tubular cells, for increased SGLT2 expression, increased production of collagen IV and extracellular matrix, and activation of monocyte/macrophages able to cause endothelial injury. The use of SGLT2 inhibitors not only reduces the reabsorption of glucose from the glomerular filtrate back into the circulationthus improving metabolic control in diabetesbut also restores tubuloglomerular feedback by increasing glycosuria and distal urinary flow. However, the most notable effect is due to inhibition of glucose entry to the proximal tubular cells. Glycosuria is toxic to the kidney: it harms glucosetransporting cells, that is, the proximal cells, which contain SGLT2. In animal models, SGLT2 inhibition reduces local production of oxygen-free radicals, the formation of mesangial matrix and collagen IV

  17. The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting

    Science.gov (United States)

    Heringlake, Matthias; Wernerus, Marit; Grünefeld, Julia; Klaus, Stephan; Heinze, Hermann; Bechtel, Matthias; Bahlmann, Ludger; Poeling, Jochen; Schön, Julika

    2007-01-01

    Introduction Myocardial dysfunction necessitating inotropic support is a typical complication after on-pump cardiac surgery. This prospective, randomized pilot study analyzes the metabolic and renal effects of the inotropes adrenaline and milrinone in patients needing inotropic support after coronary artery bypass grafting (CABG). Methods During an 18-month period, 251 patients were screened for low cardiac output upon intensive care unit (ICU) admission after elective, isolated CABG surgery. Patients presenting with a cardiac index (CI) of less than 2.2 liters/minute per square meter upon ICU admission – despite adequate mean arterial (titrated with noradrenaline or sodium nitroprusside) and filling pressures – were randomly assigned to 14-hour treatment with adrenaline (n = 7) or milrinone (n = 11) to achieve a CI of greater than 3.0 liters/minute per square meter. Twenty patients not needing inotropes served as controls. Hemodynamics, plasma lactate, pyruvate, glucose, acid-base status, insulin requirements, the urinary excretion of alpha-1-microglobuline, and creatinine clearance were determined during the treatment period, and cystatin-C levels were determined up to 48 hours after surgery (follow-up period). Results After two to four hours after ICU admission, the target CI was achieved in both intervention groups and maintained during the observation period. Plasma lactate, pyruvate, the lactate/pyruvate ratio, plasma glucose, and insulin doses were higher (p milrinone or control conditions. The urinary excretion of alpha-1-microglobuline was higher in the adrenaline than in the control group 6 to 14 hours after admission (p milrinone or the control group after 48 hours (p milrinone – is associated with unwarranted metabolic and renal effects. Clinical trials registration: ClinicalTrials.gov NCT00446017. PMID:17470271

  18. No effect of dietary fish oil on renal hemodynamics, tubular function, and renal functional reserve in long-term renal transplant recipients

    DEFF Research Database (Denmark)

    Hansen, J M; Løkkegaard, H; Høy, Carl-Erik

    1995-01-01

    Dietary supplementation with fish oil rich in n-3 polyunsaturated fatty acids has been suggested to protect the kidney against cyclosporin A (CsA) toxicity. This study investigated the effects of a 10-wk dietary supplementation with fish oil on renal function and renal functional reserve in healt...... transplant recipients treated with a low maintenance dose of CsA had a well-preserved renal functional reserve, and dietary supplementation with fish oil in these patients did not improve renal function.......Dietary supplementation with fish oil rich in n-3 polyunsaturated fatty acids has been suggested to protect the kidney against cyclosporin A (CsA) toxicity. This study investigated the effects of a 10-wk dietary supplementation with fish oil on renal function and renal functional reserve in healthy...... volunteers (N = 9) and two groups of stable long-term kidney-transplanted patients treated with maintenance low-dose CsA (3.0 +/- 0.6 mg/kg; N = 9) or without CsA (N = 9). After an overnight fast, the subjects were water loaded, and clearance studies were performed, postponing morning medication. GFR...

  19. Evaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors

    International Nuclear Information System (INIS)

    Kawamoto, S.; Lawler, L.P.; Fishman, E.K.

    2005-01-01

    Objective: The objective of our study was to assess whether both renal arteries and renal veins can be evaluated using single-phase MDCT data sets alone to eliminate the need for both arterial and venous phase data sets. Materials and methods: One hundred consecutive potential living renal donors who underwent 4- MDCT were evaluated. CT was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Both late arterial and venous phase acquisitions were obtained at 25 and 55 sec from the start of IV contrast injection, respectively. The number of the right and left renal veins and its anatomic variations were assessed by two reviewers. Late arterial phase images were evaluated initially, and then venous phase images were analyzed to assess opacification of the renal vein and to see whether venous phase data sets changed or added information about the venous anatomy as seen on late arterial phase images. Results: The retroaortic left renal vein was found in two subjects, and the circumaortic left renal vein was detected in three subjects. The renal veins were adequately opacified on late arterial phase images in all subjects. There were six subjects who had a normal left renal vein with a small posterior branch coursing posterior to the aorta and draining into the inferior vena cava, which were difficult to differentiate from the lumbar vein or ascending lumbar vein; in three of these six subjects, the small posterior branch was opacified only on venous phase images. Conclusion: Late arterial phase images obtained at 25 sec after the start of contrast injection can reveal the renal vein anatomy except for a small posterior branch of the left renal vein difficult to differentiate from the lumbar or ascending lumbar vein, as seen in three subjects. The data suggest that venous phase imaging is not necessary for the evaluation of renal vein anatomy. (author)

  20. Evaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors

    Energy Technology Data Exchange (ETDEWEB)

    Kawamoto, S.; Lawler, L.P.; Fishman, E.K. [Johns Hopkins Hospital, Baltimore, MD (United States). The Russell H. Morgan Department of Radiology and Radiological Science

    2005-03-15

    Objective: The objective of our study was to assess whether both renal arteries and renal veins can be evaluated using single-phase MDCT data sets alone to eliminate the need for both arterial and venous phase data sets. Materials and methods: One hundred consecutive potential living renal donors who underwent 4- MDCT were evaluated. CT was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Both late arterial and venous phase acquisitions were obtained at 25 and 55 sec from the start of IV contrast injection, respectively. The number of the right and left renal veins and its anatomic variations were assessed by two reviewers. Late arterial phase images were evaluated initially, and then venous phase images were analyzed to assess opacification of the renal vein and to see whether venous phase data sets changed or added information about the venous anatomy as seen on late arterial phase images. Results: The retroaortic left renal vein was found in two subjects, and the circumaortic left renal vein was detected in three subjects. The renal veins were adequately opacified on late arterial phase images in all subjects. There were six subjects who had a normal left renal vein with a small posterior branch coursing posterior to the aorta and draining into the inferior vena cava, which were difficult to differentiate from the lumbar vein or ascending lumbar vein; in three of these six subjects, the small posterior branch was opacified only on venous phase images. Conclusion: Late arterial phase images obtained at 25 sec after the start of contrast injection can reveal the renal vein anatomy except for a small posterior branch of the left renal vein difficult to differentiate from the lumbar or ascending lumbar vein, as seen in three subjects. The data suggest that venous phase imaging is not necessary for the evaluation of renal vein anatomy. (author)

  1. Metabolic and hemodynamic effects of sodium-dependent glucose cotransporter 2 inhibitors on cardio-renal protection in the treatment of patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Kashiwagi, Atsunori; Maegawa, Hiroshi

    2017-07-01

    The specific sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) inhibit glucose reabsorption in proximal renal tubular cells, and both fasting and postprandial glucose significantly decrease because of urinary glucose loss. As a result, pancreatic β-cell function and peripheral insulin action significantly improve with relief from glucose toxicity. Furthermore, whole-body energy metabolism changes to relative glucose deficiency and triggers increased lipolysis in fat cells, and fatty acid oxidation and then ketone body production in the liver during treatment with SGLT2 inhibitors. In addition, SGLT2 inhibitors have profound hemodynamic effects including diuresis, dehydration, weight loss and lowering blood pressure. The most recent findings on SGLT2 inhibitors come from results of the Empagliflozin, Cardiovascular Outcomes and Mortality in Type 2 Diabetes trial. SGLT2 inhibitors exert extremely unique and cardio-renal protection through metabolic and hemodynamic effects, with long-term durability on the reduction of blood glucose, bodyweight and blood pressure. Although a site of action of SGLT2 inhibitors is highly specific to inhibit renal glucose reabsorption, whole-body energy metabolism, and hemodynamic and renal functions are profoundly modulated during the treatment of SGLT2 inhibitors. Previous studies suggest multifactorial clinical benefits and safety concerns of SGLT2 inhibitors. Although ambivalent clinical results of this drug are still under active discussion, the present review summarizes promising recent evidence on the cardio-renal and metabolic benefits of SGLT2 inhibitors in the treatment of type 2 diabetes. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

  2. Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sildiroglu, Onur; Saad, Wael E.; Hagspiel, Klaus D.; Matsumoto, Alan H.; Turba, Ulku Cenk, E-mail: Turba@me.com [University of Virginia Health System, Department of Radiology (United States)

    2012-12-15

    Purpose: Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. Methods: This retrospective study (2003-2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24-68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. Results: We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500-700 micron embospheres to control active bleeding. The remaining two patients had large-sized ({>=}50 mm), centrally located renal pseudoaneurysms treated with thrombin {+-} coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1-67) months). Conclusions: Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

  3. Arterial Transit Time-corrected Renal Blood Flow Measurement with Pulsed Continuous Arterial Spin Labeling MR Imaging.

    Science.gov (United States)

    Shimizu, Kazuhiro; Kosaka, Nobuyuki; Fujiwara, Yasuhiro; Matsuda, Tsuyoshi; Yamamoto, Tatsuya; Tsuchida, Tatsuro; Tsuchiyama, Katsuki; Oyama, Nobuyuki; Kimura, Hirohiko

    2017-01-10

    The importance of arterial transit time (ATT) correction for arterial spin labeling MRI has been well debated in neuroimaging, but it has not been well evaluated in renal imaging. The purpose of this study was to evaluate the feasibility of pulsed continuous arterial spin labeling (pcASL) MRI with multiple post-labeling delay (PLD) acquisition for measuring ATT-corrected renal blood flow (ATC-RBF). A total of 14 volunteers were categorized into younger (n = 8; mean age, 27.0 years) and older groups (n = 6; 64.8 years). Images of pcASL were obtained at three different PLDs (0.5, 1.0, and 1.5 s), and ATC-RBF and ATT were calculated using a single-compartment model. To validate ATC-RBF, a comparative study of effective renal plasma flow (ERPF) measured by 99m Tc-MAG3 scintigraphy was performed. ATC-RBF was corrected by kidney volume (ATC-cRBF) for comparison with ERPF. The younger group showed significantly higher ATC-RBF (157.68 ± 38.37 mL/min/100 g) and shorter ATT (961.33 ± 260.87 ms) than the older group (117.42 ± 24.03 mL/min/100 g and 1227.94 ± 226.51 ms, respectively; P renal ASL-MRI as debated in brain imaging.

  4. Studies of the mechanism of contralateral polyuria after renal artery stenosis.

    Science.gov (United States)

    Galvez, O G; Roberts, B W; Mishkind, M H; Bay, W H; Ferris, T F

    1977-01-01

    Acute renal artery stenosis in hydropenic dogs caused a contralateral increase in urine volume and free water clearance without change in glomerular filtration, renal blood flow, or osmolar clearance. The increase in urine volume was not dependent on the development of hypertension since it occurred in animals pretreated with trimethaphan but was dependent upon angiotensin since it was presented with angiotensin blockade with Saralasin. The effect was not caused by angiotensin inhibiting antidiuretic hormone release since the polyuria occurred in hypophysectomized animals receiving a constant infusion of 10 muU/kg per min of aqueous Pitressin. Since the rise in urine volume was associated with an increase in renal vein prostaglandin E concentration and was prevented by pretreatment with indomethacin (5 mg/kg) the results suggest that the rise in plasma angiotensin after renal artery stenosis causes an increase in contralateral prostaglandin E synthesis with resultant antagonism to antidiuretic hormone at the collecting tubule. PMID:845253

  5. Exogenous L-Arginine Attenuates the Effects of Angiotensin II on Renal Hemodynamics and the Pressure Natriuresis-Diuresis Relationship

    Science.gov (United States)

    Das, Satarupa; Mattson, David L.

    2014-01-01

    SUMMARY Administration of exogenous L-Arginine (L-Arg) attenuates Angiotensin II (AngII)-mediated hypertension and kidney disease in rats. The present study assessed renal hemodynamics and pressure-diuresis-natriuresis in anesthetized rats infused with vehicle, AngII (20 ng/kg/min, iv) or AngII + L-Arg (300 µg/kg/min, iv). Increasing renal perfusion pressure (RPP) from approximately 100 to 140 mmHg resulted in a 9–10 fold increase in urine flow and sodium excretion rate in control animals. In comparison, AngII infusion significantly reduced renal blood flow (RBF) and glomerular filtration rate (GFR) by 40–42% and blunted the pressure-dependent increase in urine flow and sodium excretion rate by 54–58% at elevated RPP. Supplementation of L-Arg reversed the vasoconstrictor effects of AngII and restored pressure-dependent diuresis to levels not significantly different from control rats. Experiments in isolated aortic rings were performed to assess L-Arg effects on the vasculature. Dose-dependent contraction to AngII (10−10M to 10−7M) was observed with a maximal force equal to 27±3% of the response to 10−5M phenylephrine. Contraction to 10−7M AngII was blunted by 75±3% with 10−4M L-Arg. The influence of L-Arg to blunt AngII mediated contraction was eliminated by endothelial denudation or incubation with nitric oxide synthase inhibitors. Moreover, the addition of 10−3M cationic or neutral amino acids, which compete with L-Arg for cellular uptake, blocked the effect of L-Arg. Anionic amino acids did not influence the effects of L-Arg on AngII-mediated contraction. These studies indicate that L-Arg blunts AngII-mediated vascular contraction by an endothelial- and NOS-dependent mechanism involving cellular uptake of L-Arg. PMID:24472006

  6. Hemodynamic patterns of anterior communicating artery aneurysms: a possible association with rupture

    Science.gov (United States)

    Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

    2007-03-01

    The aim of this study is to characterize the different flows present at anterior communicating artery (AcoA) aneurysms and investigate possible associations with rupture. For that purpose, patient-specific computational models of 26 AcoA aneurysms were constructed from 3D rotational angiography images. Bilateral images were acquired in 15 patients who had both A1 segments of the anterior cerebral arteries and models were created by fusing the reconstructed left and right arterial trees. Computational fluid dynamics simulations were performed under pulsatile flow conditions. Visualizations of the flow velocity pattern were created to classify the aneurysms into the following flow types: A) inflow from both A1 segments, B) flow jet in the parent artery splits into three secondary jets, one enters the aneurysm and the other two are directed to the A2 segments, C) the parent artery jet splits into two secondary jets, one is directed to one of the A2 segments and the other enters the aneurysm before being directed to the other A2 segment, and D) the parent artery jet enters the aneurysm before being directed towards the A2 segments. The maximum wall shear stress in the aneurysm at the systolic peak (MWSS) was calculated. Most aneurysms in group A were unruptured and had the lowest MWSS. Group B had the same number of unruptured and ruptured aneurysms, and a low MWSS. Groups C and D had high rupture ratios, being the average MWSS significantly higher in group C. Finally, it was found that the MWSS was higher for ruptured aneurysms of all flow types.

  7. Multislice CT Angiography in Renal Artery Stent Evaluation: Prospective Comparison with Intra-Arterial Digital Subtraction Angiography

    International Nuclear Information System (INIS)

    Raza, Syed A.; Chughtai, Aamer R.; Wahba, Mona; Cowling, Mark G.; Taube, David; Wright, Andrew R.

    2004-01-01

    Purpose: To assess the role of multislice computed tomography angiography (MCTA) in the evaluation of renal artery stents, using intra-arterial digital subtraction angiography (DSA) as the gold standard. Methods: Twenty consecutive patients (15 men, 5 women) with 23 renal artery stents prospectively underwent both MCTA and DSA. Axial images, multiplanar reconstructions and maximum intensity projection images were used for diagnosis. The MCTA and DSA images were each interpreted without reference to the result of the other investigation. Results:The three cases of restenosis on DSA were detected correctly by MCTA; in 19 cases where MCTA showed a fully patent stent, the DSA was also negative. Sensitivity and negative predictive value (NPV) of MCTA were therefore 100%. In four cases, MCTA showed apparently minimal disease which was not shown on DSA. These cases are taken as false positive giving a specificity of 80% and a positive predictive value of 43%. Conclusion: The high sensitivity and NPV suggest MCTA may be useful as a noninvasive screen for renal artery stentrestenosis. MCTA detected mild disease in a few patients which was not confirmed on angiography

  8. Evaluation of functional severity of coronary artery disease and fluid dynamics' influence on hemodynamic parameters: A review.

    Science.gov (United States)

    Govindaraju, Kalimuthu; Badruddin, Irfan Anjum; Viswanathan, Girish N; Ramesh, S V; Badarudin, A

    2013-05-01

    Coronary Artery Disease (CAD) is responsible for most of the deaths in patients with cardiovascular diseases. Diagnostic coronary angiography analysis offers an anatomical knowledge of the severity of the stenosis. The functional or physiological significance is more valuable than the anatomical significance of CAD. Clinicians assess the functional severity of the stenosis by resorting to an invasive measurement of the pressure drop and flow. Hemodynamic parameters, such as pressure wire assessment fractional flow reserve (FFR) or Doppler wire assessment coronary flow reserve (CFR) are well-proven techniques to evaluate the physiological significance of the coronary artery stenosis in the cardiac catheterization laboratory. Between the two techniques mentioned above, the FFR is seen as a very useful index. The presence of guide wire reduces the coronary flow which causes the underestimation of pressure drop across the stenosis which leads to dilemma for the clinicians in the assessment of moderate stenosis. In such condition, the fundamental fluid mechanics is useful in the development of new functional severity parameters such as pressure drop coefficient and lesion flow coefficient. Since the flow takes place in a narrowed artery, the blood behaves as a non-Newtonian fluid. Computational fluid dynamics (CFD) allows a complete coronary flow simulation to study the relationship between the pressure and flow. This paper aims at explaining (i) diagnostic modalities for the evaluation of the CAD and valuable insights regarding FFR in the evaluation of the functional severity of the CAD (ii) the role of fluid dynamics in measuring the severity of CAD. Copyright © 2012 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  9. [Endovascular radiofrequency denervation of renal arteries as an innovation method of treatment of refractory arterial hypertension. First experience in Russia].

    Science.gov (United States)

    Danilov, N M; Matchin, Iu G; Chazova, I E

    2012-01-01

    Excessive activation of the sympathetic nervous system forms the basis of pathogenesis of essential arterial hypertension (AH). The present work was aimed at evaluating efficacy and safety of endovascular radiofrequency denervation of renal arteries in patients with AH refractory AH based on the initial first experience in with using this methodology in the Russian Federation. The interventions were carried out on December 14-15th, 2011 in the first five patients presenting with AH refractory to antihypertensive therapy consisting of three and more drugs in therapeutic doses, one of which was a diuretic. The selection criteria were systolic arterial pressure (SAP) ≥160 mm Hg or ≥150 mm Hg in the presence of type 2 diabetes mellitus. The obligatory conditions for selection were the preserved renal function [glomerular filtration rate (GFR) ≥45 ml/min] and the absence of the secondary form of AH. The procedure of denervation was performed in the conditions of roentgen-operating room using special Medtronic Ardian Simplicity Catheter System™. In all cases we managed to perform bilateral denervation of renal arteries with the radiofrequency effect in not less than 4 zones of each of vessels. Efficacy of each of the effect was registered with due regard for reaching certain temperature and values of impedance. The interventions were not accompanied by the development of any complications either in the area of manipulations or the site of puncture. Neither were there any complications from the side of the cardiovascular or excretory systems of the body. Diurnal monitoring of AP (DMAP) registered a significant decrease in SAP averagely from 174±12 to 145±10 mm Hg three days after the intervention. A persistent antihypertensive effect was confirmed by the DMAP findings one month after denervation - the SAP level averagely amounted to 131±6 mm Hg. Endovascular radiofrequency denervation of renal arteries is a safe and efficient method of treatment of AH resistant

  10. An Update on Renal Artery Denervation and Its Clinical Impact on Hypertensive Disease

    OpenAIRE

    Bhat, Aditya; Kuang, Ye Min; Gan, Gary C. H.; Burgess, David; Denniss, Alan Robert

    2015-01-01

    Hypertension is a globally prevalent condition, with a heavy clinical and economic burden. It is the predominant risk factor for premature cardiovascular and cerebrovascular disease, and is associated with a variety of clinical disorders including stroke, congestive cardiac failure, ischaemic heart disease, chronic renal failure, and peripheral arterial disease. A significant subset of hypertensive patients have resistant hypertensive disease. In this group of patients, catheter-based renal a...

  11. Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study

    International Nuclear Information System (INIS)

    Ozbek, Orhan; Acar, Kadir; Koc, Osman; Saritas, Kadir; Toy, Hatice; Solak, Yalcin; Ozbek, Seda; Kucukapan, Ahmet; Guler, Ibrahim; Gaipov, Abduzhappar; Turk, Suleyman; Haznedaroglu, Ibrahim Celaleddin

    2013-01-01

    Renal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80–90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10–20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.

  12. Short-Term Effects of Ankaferd Hemostat for Renal Artery Embolization: An Experimental Study

    Energy Technology Data Exchange (ETDEWEB)

    Ozbek, Orhan, E-mail: orhan.ozbek@gmail.com [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Acar, Kadir [Selcuk University, Division of Hematology, Department of Internal Medicine, Meram School of Medicine (Turkey); Koc, Osman [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Saritas, Kadir [Afyon Kocatepe University, Department of General Surgery, Veterinary Faculty (Turkey); Toy, Hatice [Selcuk University, Department of Pathology, Meram School of Medicine (Turkey); Solak, Yalcin [Selcuk University, Division of Nephrology, Department of Internal Medicine, Meram School of Medicine (Turkey); Ozbek, Seda [Selcuk University, Department of Radiology, Selcuklu School of Medicine (Turkey); Kucukapan, Ahmet; Guler, Ibrahim [Selcuk University, Department of Radiology, Meram School of Medicine (Turkey); Gaipov, Abduzhappar; Turk, Suleyman [Selcuk University, Division of Nephrology, Department of Internal Medicine, Meram School of Medicine (Turkey); Haznedaroglu, Ibrahim Celaleddin [Hacettepe University, Division of Hematology, Department of Internal Medicine, Faculty of Medicine (Turkey)

    2013-04-15

    Renal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model. Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental. The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %). RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.

  13. Can an accessory renal artery be safely covered during endovascular aortic aneurysm repair?

    OpenAIRE

    Antoniou, George A.; Karkos, Christos D.; Antoniou, Stavros A.; Georgiadis, George S.

    2013-01-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether coverage of an accessory renal artery (ARA) in patients undergoing endovascular aortic aneurysm repair (EVAR) is associated with increased risk of renal impairment. Altogether, 106 papers were located using the reported searches, of which 5 represented the best evidence to answer the question. The authors, journal, date and country of publication, study type, patient group studied, rel...

  14. Hemodynamic evaluation in patients with superficial temporal artery-middle cerebral artery anastomosis; Stable xenon CT-CBF study and acetazolamide

    Energy Technology Data Exchange (ETDEWEB)

    Touho, Hajime; Karasawa, Jun; Shishido, Hisashi; Morisako, Toshitaka; Yamada, Keisuke; Shibamoto, Keiji [Osaka Neurological Inst., Toyonaka (Japan)

    1990-12-01

    Sixteen patients with minor completed stroke in the chronic stage underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The acetazolamide-activated regional cerebral blood flow (rCBF) was measured 20 minutes after the injection using inhalation of stable xenon and computed tomographic scanning (Xe{sup s} CT-CBF study) pre- and postoperatively. Eleven patients (Group 1) showed immediate improvement in neurological state within a few days of the operation, while five (Group 2) showed no improvements. Preoperative rCBF in the ischemic areas without infarction was 30.8+-3.0 ml/100 gm/min in Group 1 and 53.0+-5.2 ml/100 gm/min in Group 2. Preoperative vasodilatory capacity with acetazolamide in Group 1 was 5.7+-8.6 and significantly increased to 19.8+-4.9 after surgery. In Group 2, pre- and postoperative vasodilatory capacity was 12.7+-3.1 and 14.9+-2.9, respectively, and there was no significant change. These results suggested that minor stroke patients with moderate decrease of affected side rCBF (less than 40 ml/100 gm/min) and with hemodynamic impairment may have the surgical indication for STA-MCA anastomosis. (author).

  15. An Update on Renal Artery Denervation and Its Clinical Impact on Hypertensive Disease

    Directory of Open Access Journals (Sweden)

    Aditya Bhat

    2015-01-01

    Full Text Available Hypertension is a globally prevalent condition, with a heavy clinical and economic burden. It is the predominant risk factor for premature cardiovascular and cerebrovascular disease, and is associated with a variety of clinical disorders including stroke, congestive cardiac failure, ischaemic heart disease, chronic renal failure, and peripheral arterial disease. A significant subset of hypertensive patients have resistant hypertensive disease. In this group of patients, catheter-based renal artery denervation has emerged as a potential therapy, with favourable clinical efficacy and safety in early trials. Additional benefits of this therapy are also being identified and include effects on left ventricular remodeling, cardiac performance, and symptom status in congestive cardiac failure. Utility of renal denervation for the management of resistant hypertension, however, has become controversial since the release of the Symplicity HTN-3 trial, the first large-scale blinded randomised study investigating the efficacy and safety of renal artery denervation. The aim of this paper is to evaluate the history, utility, and clinical efficacy of renal artery denervation technology, including an in-depth appraisal of the current literature and principal trials.

  16. An Update on Renal Artery Denervation and Its Clinical Impact on Hypertensive Disease

    Science.gov (United States)

    Kuang, Ye Min; Gan, Gary C. H.; Burgess, David; Denniss, Alan Robert

    2015-01-01

    Hypertension is a globally prevalent condition, with a heavy clinical and economic burden. It is the predominant risk factor for premature cardiovascular and cerebrovascular disease, and is associated with a variety of clinical disorders including stroke, congestive cardiac failure, ischaemic heart disease, chronic renal failure, and peripheral arterial disease. A significant subset of hypertensive patients have resistant hypertensive disease. In this group of patients, catheter-based renal artery denervation has emerged as a potential therapy, with favourable clinical efficacy and safety in early trials. Additional benefits of this therapy are also being identified and include effects on left ventricular remodeling, cardiac performance, and symptom status in congestive cardiac failure. Utility of renal denervation for the management of resistant hypertension, however, has become controversial since the release of the Symplicity HTN-3 trial, the first large-scale blinded randomised study investigating the efficacy and safety of renal artery denervation. The aim of this paper is to evaluate the history, utility, and clinical efficacy of renal artery denervation technology, including an in-depth appraisal of the current literature and principal trials. PMID:26495305

  17. Association of Live Donor Nephrectomy and Reversal of Renal Artery Spasm

    Directory of Open Access Journals (Sweden)

    Jalal Azmandian

    2014-01-01

    Full Text Available Background: Kidney transplantation is the best treatment option for kidney failure. Major medical progress has been made in the field of renal transplantation over the last 40 years. The surgical procedure has been standardized and the complication rate is low. Overall, the outcome of renal transplantation is excellent and has improved over time. Vascular complications after renal transplantation are the most frequent type of complication following urological complications. Renal artery spasm (RAS following manipulation of renal artery is a common problem during live donor nephrectomy (LDN. The aim of this study was to determine whether or not it is necessary to wait for reverse of RAS and resumption of urinary flow before nephrectomy. Materials and Methods: In this clinical trial 16 cases of LDN who developed RAS during surgery received intra-arterial injection of 40 mg papaverine. In 8 cases surgery continued towards nephrectomy and in other 8 cases we waited for reverse of RAS. All analyses were performed using SPSS-11. Results: In both groups urinary flow started a few minutes (Mean, 12 min after declamping of transplanted kidney and normal renal consistency and color were achieved. There was no significant difference between urinary volume during 12 h after transplantation in two groups. Conclusion: The results showed that it might not be necessary to wait for reverse of RAS before LDN. Both patient (less anesthesia complications and hospital (less expenses will benefit from this time saving.

  18. Percutaneous transluminal angioplasty of renal artery: therapeutic experience of 31 patients

    International Nuclear Information System (INIS)

    Kim, Seung Cheol; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Kim, Hong Dae; Jeong, Yoong Ki; Kim, Seung Hoon; Yeon, Kyung Mo

    1995-01-01

    The purpose of this study is to introduce the experience of 31 patients who had renovascular hypertension and underwent percutaneous transluminal angioplasty of renal artery (PTA). The subjects were 31 patients with hypertension and stenotic renal artery or arteries on angiography. The criteria of stenosis is more than 50% narrowing of the artery. The technical results were considered to be successful if residual stenosis is less than 50%. The clinical results were classified as cure, improvement and fail. And clinical results were analyzed according to the follow-up duration, short term (≤6 mo) and long term (> 6 mo). Technical success rate was 90.2% (37/41) and clinical success rate were 82.8% (24/29) on short term follow-up and 84.2% (16/19) on long term follow-up. Recurred cases were 7 cases. PTA is a safe and effective therapeutic modality on renovascular hypertension

  19. Focused ultrasound-modulated glomerular ultrafiltration assessed by functional changes in renal arteries.

    Directory of Open Access Journals (Sweden)

    Feng-Yi Yang

    Full Text Available This study demonstrates the feasibility of using focused ultrasound (FUS to modulate glomerular ultrafiltration by renal artery sonication and determine if protein-creatinine ratios are estimated through vascular parameters. All animal experiments were approved by our Animal Care and Use Committee. The renal arteries of Sprague-Dawley rats were surgically exposed and sonicated at various acoustic power levels using a FUS transducer with a resonant frequency of 1 MHz. The mean peak systolic velocity (PSV of the blood flow was measured by Doppler ultrasound imaging. Urinary protein-creatinine ratios were calculated during the experiments. Histological examination of renal arteries and whole kidneys was performed. The PSV, pulsatility index, and resistance index of blood flow significantly increased in the arteries after FUS sonication without microbubbles (p<0.05. The change in normalized protein-creatinine ratios significantly increased with increasing acoustic power, but such was not observed when microbubbles were administered. Furthermore, no histological changes were observed in the hematoxylin- and eosin-stained sections. Glomerular ultrafiltration is regulated temporarily by renal artery sonication without microbubbles. Monitoring vascular parameters are useful in estimating the normalized change in protein-creatinine ratios.

  20. Effect of captopril on renal blood flow in renal artery stenosis assessed by positron tomography with rubidium-82

    International Nuclear Information System (INIS)

    Tamaki, N.; Alpert, N.M.; Rabito, C.A.; Barlai-Kovach, M.; Correia, J.A.; Strauss, H.W.

    1988-01-01

    The sequence and magnitude of acute changes in renal blood flow following administration of captopril were determined in a canine model of acute unilateral renal artery stenosis using rubidium-82 and positron emission tomography. Data were recorded in each of nine dogs under three conditions: 1) during a baseline control interval, 2) during renal artery stenosis, and 3) during stenosis with intravenous injection of captopril (1.2 mg/kg). Mean arterial blood pressure was 108 +/- 12 mm Hg at control, increased significantly to 125 +/- 13 mm Hg (p less than 0.01) during stenosis, and decreased to 98 +/- 13 mm/Hg (p less than 0.01) after captopril infusion. Mean renal blood flow was calculated using a steady state single compartment model from the images produced by positron emission tomography. The estimated flow to the affected kidney was 3.37 +/- 1.48 ml/min/g at control, 0.86 +/- 0.62 ml/min/g during stenosis (p less than 0.01), and 0.64 +/- 0.57 ml/min/g after captopril administration (p = NS compared with precaptopril value). The estimated flow to the contralateral kidney was minimally reduced from a baseline of 3.84 +/- 0.95 to 3.24 +/- 1.13 ml/min/g (p = NS) during stenosis and increased after captopril infusion (4.08 +/- 0.94 ml/min/g; p = 0.01). These data suggest that repetitive imaging with positron emission tomography can be used to delineate acute changes in renal perfusion following captopril administration

  1. The arcuate artery in renal transplants: An insensitive indicator of rejection

    International Nuclear Information System (INIS)

    McIntire, J.N.; Angtuaco, T.L.; Boyd, C.; Flanigan, W.J.

    1987-01-01

    The authors performed 65 duplex US examinations in 28 patients within 2 years of transplantation. During this time 15 episodes of rejection were diagnosed by US and confirmed clinically. Of the remaining 50 examinations, 14 showed negligible or absent diastolic flow (suggesting rejection) in the arcuate arteries with normal diastolic flow in the main renal, segmental, and interlobar branches. No other criteria for rejection were present in these patients. It is concluded that the arcuate artery is an insensitive indicator of transplant rejection

  2. A case of reocclusion of the renal artery diagnosed by the color Doppler method with evaluation of blood flow direction in the collateral circulation of the kidney in addition to the non-detectable blood signal in the renal artery.

    Science.gov (United States)

    Hirano, Megumi; Ohta, Tomoyuki; Nakata, Norio; Kawakami, Reina; Takamura, Kimihiro; Matsuda, Tosiharu; Nishioka, Makiko; Sakurai, Tomoo; Matsuo, Kouichi; Miyamoto, Yukio

    2014-10-01

    A 23-year-old woman was referred to our hospital for an interventional procedure for chronic total occlusion of the right renal artery, probably due to fibromuscular dysplasia (FMD), and for control of renal vascular hypertension. Before percutaneous transluminal renal angioplasty (PTRA), aortography revealed collateral circulation to the right kidney from the lower lumbar artery. After PTRA, however, blood flow in the renal side of the collateral circulation flowed outside from the right renal parenchyma. 4 months later, we could not find a blood flow signal in the right renal artery, and there was a contrary flow signal in the right kidney parenchyma continuously from the extrahilar vessel, possibly a collateral artery. These findings indicated reocclusion of the right artery. We confirmed reocclusion of the renal artery and collateral feeding by contrast dynamic computed tomography (CT), and PTRA was performed again without any complications or reocclusion for 5 months. This is the first case report showing that a back-flowing signal in the right renal parenchyma from the extrahilar artery is useful as an indirect finding suggesting reocclusion.

  3. Urinoma and arterial hypertension complicating neonatal renal candidiasis

    International Nuclear Information System (INIS)

    Sirinelli, D.; Schmit, P.; Biriotti, V.; Bensman, A.; Lupold, M.

    1987-01-01

    During antibiotic treatment for E.coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abcess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal. (orig.)

  4. Urinoma and arterial hypertension complicating neonatal renal candidiasis

    Energy Technology Data Exchange (ETDEWEB)

    Sirinelli, D; Schmit, P; Biriotti, V; Bensman, A; Lupold, M

    1987-02-01

    During antibiotic treatment for E.coli urinary tract infection and meningitis, a male new born developed a Candida albicans urinary tract infection with a mycotic kidney abcess and pelvicalyceal fungus balls diagnosed by US investigations and confirmed by radiology. Three weeks later a perirenal urinoma with arterial hypertension developed. After surgical treatment of the urinoma the arterial pressure returned to normal.

  5. Blood flow quantification from 2D phase contrast MRI in renal arteries using an unsupervised data driven approach

    Energy Technology Data Exchange (ETDEWEB)

    Zoellner, Frank Gerrit [Computer Assisted Clinical Medicine, Faculty of Medicine Mannheim, Univ. of Heidelberg, Mannheim (Germany); Section for Radiology, Dept. of Surgical Sciences, Univ. of Bergen (Norway); Monssen, Jan Ankar [Dept. of Radiology, Haukeland Univ. Hospital, Bergen (Norway); Roervik, Jarie [Section for Radiology, Dept. of Surgical Sciences, Univ. of Bergen (Norway); Dept. of Radiology, Haukeland Univ. Hospital, Bergen (Norway); Lundervold, Arvid [Dept. of Radiology, Haukeland Univ. Hospital, Bergen (Norway); Dept. of Biomedicine, Univ. of Bergen (Norway); Schad, Lothar R. [Computer Assisted Clinical Medicine, Faculty of Medicine Mannheim, Univ. of Heidelberg, Mannheim (Germany)

    2009-07-01

    We present a clustering approach to segment the renal artery from 2D PC Cine MR images to measure arterial blood velocity and flow. Such information is important in grading renal artery stenosis and to support the decision on surgical interventions like percutaneous transluminal angioplasty. Results from 20 data sets (volunteers, 7 patients) show that the renal arteries could be extracted automatically and the corresponding velocity profiles were close (r = 0.977) to that obtained by manual delineations of the vessel areas. (orig.)

  6. Blood flow quantification from 2D phase contrast MRI in renal arteries using an unsupervised data driven approach

    International Nuclear Information System (INIS)

    Zoellner, Frank Gerrit; Monssen, Jan Ankar; Roervik, Jarie; Lundervold, Arvid; Schad, Lothar R.

    2009-01-01

    We present a clustering approach to segment the renal artery from 2D PC Cine MR images to measure arterial blood velocity and flow. Such information is important in grading renal artery stenosis and to support the decision on surgical interventions like percutaneous transluminal angioplasty. Results from 20 data sets (volunteers, 7 patients) show that the renal arteries could be extracted automatically and the corresponding velocity profiles were close (r = 0.977) to that obtained by manual delineations of the vessel areas. (orig.)

  7. The benefit of stent placement and blood pressure and lipid-lowering for the prevention of progression of renal dysfunction caused by atherosclerotic ostial stenosis of the renal artery. The STAR-study: rationale and study design.

    NARCIS (Netherlands)

    Bax, L.; Mali, W.P.Th.; Buskens, E.; Koomans, H.A.; Beutler, J.J.; Braam, B.; Beek, F.J.A.; Rabelink, T.J.; Postma, C.T.; Huysmans, F.T.M.; Deinum, J.; Thien, Th.; Schultze Kool, L.J.; Woittiez, A.J.J.; Kouwenberg, J.J.; Meiracker, A.H. van den; Pattynama, P.M.; Ven, P.J. van der; Vroegindeweij, D.; Doorenbos, C.J.; Aarts, J.; Kroon, A.A.; Leeuw, P.W. de; Haan, M.W. de; Engelshoven, J. van; Rutten, M.J.C.M.; Montfrans, G.A. van; Reekers, J.A.; Plouin, P.F.; Batide Alanore, A. La; Azizi, M.; Raynaud, A.; Harden, P.N.; Cowling, M.

    2003-01-01

    BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is associated with progressive loss of renal function and is one of the most important causes of renal failure in the elderly. Current treatment includes restoration of the renal arterial lumen by endovascular stent placement. However, this

  8. Magnetization Transfer Magnetic Resonance Imaging Noninvasively Detects Renal Fibrosis in Swine Atherosclerotic Renal Artery Stenosis at 3.0 T.

    Science.gov (United States)

    Jiang, Kai; Ferguson, Christopher M; Woollard, John R; Zhu, Xiangyang; Lerman, Lilach O

    2017-11-01

    Renal fibrosis is a useful biomarker for diagnosis and evaluation of therapeutic interventions of renal diseases but often requires invasive testing. Magnetization transfer magnetic resonance imaging (MT-MRI), which evaluates the presence of macromolecules, offers a noninvasive tool to probe renal fibrosis in murine renal artery stenosis (RAS) at 16.4 T. In this study, we aimed to identify appropriate imaging parameters for collagen detection at 3.0 T MRI and to test the utility of MT-MRI in measuring renal fibrosis in a swine model of atherosclerotic RAS (ARAS). To select the appropriate offset frequency, an MT-MRI study was performed on a phantom containing 0% to 40% collagen I and III with offset frequencies from -1600 to +1600 Hz and other MT parameters empirically set as pulse width at 16 milliseconds and flip angle at 800 degrees. Then selected MT parameters were used in vivo on pigs 12 weeks after sham (n = 8) or RAS (n = 10) surgeries. The ARAS pigs were fed with high-cholesterol diet to induce atherosclerosis. The MT ratio (MTR) was compared with ex vivo renal fibrosis measured using Sirius-red staining. Offset frequencies at 600 and 1000 Hz were selected for collagen detection without direct saturation of free water signal, and subsequently applied in vivo. The ARAS kidneys showed mild cortical and medullary fibrosis by Sirius-red staining. The cortical and medullary MTRs at 600 and 1000 Hz were both increased. Renal fibrosis measured ex vivo showed good linear correlations with MTR at 600 (cortex: Pearson correlation coefficient r = 0.87, P 3.0 T. Therefore, MT-MRI may potentially be clinically applicable and useful for detection and monitoring of renal pathology in subjects with RAS.

  9. Circumferential targeted renal sympathetic nerve denervation with preservation of the renal arterial wall using intra-luminal ultrasound

    Science.gov (United States)

    Roth, Austin; Coleman, Leslie; Sakakura, Kenichi; Ladich, Elena; Virmani, Renu

    2015-03-01

    An intra-luminal ultrasound catheter system (ReCor Medical's Paradise System) has been developed to provide circumferential denervation of the renal sympathetic nerves, while preserving the renal arterial intimal and medial layers, in order to treat hypertension. The Paradise System features a cylindrical non-focused ultrasound transducer centered within a balloon that circulates cooling fluid and that outputs a uniform circumferential energy pattern designed to ablate tissues located 1-6 mm from the arterial wall and protect tissues within 1 mm. RF power and cooling flow rate are controlled by the Paradise Generator which can energize transducers in the 8.5-9.5 MHz frequency range. Computer simulations and tissue-mimicking phantom models were used to develop the proper power, cooling flow rate and sonication duration settings to provide consistent tissue ablation for renal arteries ranging from 5-8 mm in diameter. The modulation of these three parameters allows for control over the near-field (border of lesion closest to arterial wall) and far-field (border of lesion farthest from arterial wall, consisting of the adventitial and peri-adventitial spaces) depths of the tissue lesion formed by the absorption of ultrasonic energy and conduction of heat. Porcine studies have confirmed the safety (protected intimal and medial layers) and effectiveness (ablation of 1-6 mm region) of the system and provided near-field and far-field depth data to correlate with bench and computer simulation models. The safety and effectiveness of the Paradise System, developed through computer model, bench and in vivo studies, has been demonstrated in human clinical studies.

  10. Percutaneous Transluminal Angioplasty of Dysplastic Stenoses of the Renal Artery: Results on 70 Adults

    International Nuclear Information System (INIS)

    Fraissinette, Bruno de; Garcier, Jean Marc; Dieu, Valerie; Mofid, Reza; Ravel, Anne; Boire, Jean Yves; Boyer, Louis

    2003-01-01

    Purpose: Retrospective analysis of the dilatation (PTRA) of renal arterial dysplastic stenosis (RADS). Methods: Seventy patients suffering from hypertension (87RADS) were treated at our institution for medial (83%) or non-classified fibrodysplasias (17%). Four patients suffered from renal insufficiency. Two endoprostheses were implanted. We evaluated blood pressure with the USCSRH criteria and renal insufficiency with the Martin criteria. Results: Ninety-five percent technical success and 87.9% clinical success for blood pressure were obtained, with worse results for patients older than 57 years or with a history of hypertension greater than 9 years. Results were better when the RADS was responsible for an ipsilateral renal atrophy or for poorly controlled hypertension. No renal insufficiency worsened during the follow-up. Conclusion: PTRA is a first-line treatment for renovascular hypertension caused by RADS. The results were encouraging despite a high average age of the subjects and frequent associated extrarenal vascular lesions

  11. An unusual renal accessory artery originating from the thoracic aorta and its potential clinical implications

    Directory of Open Access Journals (Sweden)

    Elvira Talović

    2013-05-01

    Full Text Available We report a case of an unsual anatomical vascular blood supply to the right kidney. In an analysis of kidneys, by dissection of 39 foetuses, additional renal arteries were found in 18 cases (46.15%. In only one case (2.5% was it noticed that the right kidney was supplied with blood by three renal arteries, one main and two additional arteries. One of the additional arteries, marked as the upper pole artery of aortic origin, separated from the thoracic aorta at the level of T11 (the eleventh thoracic rib, 1.5 cm above the truncus coeliacus. This artery, after passing through the diaphragm, entered the renal hilus at its upper part and served to vasculate that part of the kidney. Conclusion. The importance of this study is seen in the fact that anatomic knowledge of variations in the vascularization of the kidneys is of exceptional practical importance. Also, this information may concern transplant surgeons involved in living donor nephrectomies.

  12. One Year Clinical Outcomes of Renal Artery Stenting: The Results of ODORI Registry

    International Nuclear Information System (INIS)

    Sapoval, M.; Tamari, I.; Goffette, P.; Downes, M.; Senechal, Q.; Fanelli,